Inspection on 12/01/06 for West Street, 36

This inspection was carried out on 12th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Street, 36 09/05/07

West Street, 36 08/06/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 West Street, 36 36 West Street Wombwell Barnsley S73 8LA Lead Inspector Mrs Sue Stephens Unannounced Inspection 12th January 2006 09:30 West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 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 West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 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. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service West Street, 36 Address 36 West Street Wombwell Barnsley S73 8LA 01226 757269 01226 759573 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) Milbury Care Services Mrs Karen Armitage Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user as identified on the variation application dated 14.9.05 (who is over the age of 65 years) may be accommodated at the home. Date of last inspection Brief Description of the Service: 36 West Street is a new purpose built home set in its own grounds. It provides care and accommodation for people with learning disabilities. The lay out and equipment at the home is suitable for people with physical disabilities. There is a passenger lift providing access to both levels. On the ground floor there is a lounge, activities room, dining area and purpose built kitchen. The four bedrooms have direct access to a bathroom or shower area. On the first level floor there are two self-contained flats. The bedrooms and shared spaces exceed the National Minimum Standards for room sizes. There are good amenities, for example shops, pubs, a church and leisure facilities situated close to the home. Wombwell shopping centre is a short walk from the home and there is public transport into Barnsley town. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 36 West Street was registered with the Commission in September 2005; and was the first inspection for the home. Inspectors Sue Stephens and Chris Rolt carried out the inspection. The manager, Karen Armitage was off duty, and the acting senior carer and carer assisted in the inspection. Verbal feedback was given to the manager and responsible individual after the inspection date. There were three residents living at the home. Staff were observed assisting residents with their daily routines. The environment was checked and a sample of records including care plans, policies and training was checked. The inspectors acknowledge that the two staff on duty had not experienced an inspection before, and the inspectors would like to thank them for their time and assistance. The residents are also thanked for their welcome and assistance in the inspection. What the service does well: The home was bright and welcoming, and the furnishings and fittings were of high quality. Careful thought and consideration had gone into the design of the home to make sure it meets the physical needs of the residents. Residents’ bedrooms were comfortable and personalised. Two residents said they were happy with their rooms. Staff took care to make sure they assisted residents with personal needs in a private and dignified manner. There were good proposed packages of care; these took into account resident’s abilities, preferences and aspirations. A resident said he was settled at the home and had enjoyed Christmas. The staff were welcoming and helpful. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The assessments, care plans, and risk assessments need to be improved so that they can better reflect the specialist and health needs of the residents. Better records are needed about residents changing needs and clearer instructions given to staff about how to deliver care whilst a care plan is being revised. Better support and guidance needs to be given to staff to make sure they understand the complex needs of the residents, for example behaviours and ageing. This should make sure residents get consistent, positive and appropriate care. Residents who receive physical interventions need to have them carried out by following government and good practice guidelines. For example the British Institute of Learning Disabilities guidelines. This would help them to keep them safe and to make sure their rights are not compromised. The home needs to carry out the proposed packages of care better. This would make sure the residents receive the level of care agreed when they were admitted. Dietary foods need to be prepared following instruction and thought given to residents’ choice and dignity. Medication records need two signatures on hand written information. This would make sure staff do not make mistakes about the information. The cleaning schedules need to be easier and clearer for staff to follow. And the kitchen needs to be kept clean and hygienic at all times. Records relating to care plans, criminal record bureau details, induction, meals and cleaning needs to be improved. Records need to be more securely stored and maintained. The Regulation 26 provider visits need to check the home using good practice guidelines as a measure. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 7 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. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 8 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 West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 9 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, 3 and 4. The information about the home, and the introductory visits help residents to choose if the home is suitable for them, before they move in. The home needs to improve it’s staff knowledge and assessment of residents specialist and changing needs to make sure residents needs are fully met. EVIDENCE: The Statement of Purpose and Service User Guide was checked at the point of registration, they both contained the relevant information. The senior carer and carer were aware of the information and confirmed each resident, or their relatives, had been given copies. A full needs assessment had been carried out for each resident before their admission to 36 West Street. Some plans did not reflect the full assessed needs of the individual, for example dementia, the ageing process, and physical interventions. One assessment did not have the date it was carried out. One person’s assessed need had changed; the care plan had not been updated or replaced. As a result the resident was at risk of receiving inconsistent care. There is more information about this under Standard 6. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 10 Some residents at the home had specific and specialist needs, for example the home has a condition, which allows them to care for one person over the age of 65. One care plan did not include how to meet the residents’ specific need. The staff were asked about the care needs of people who had specialist needs, for example, physical intervention, mental health needs, and the ageing process. The staff could not demonstrate that they had good knowledge, confidence, and understanding to give consistent and professional care when dealing with specialist needs. The homes standard of record keeping and staff understanding about physical interventions did not follow good practice guidelines; such as government guidelines and the British Institute for Learning Disabilities. One resident spoke to the inspectors, he said he was settled and comfortable and had enjoyed Christmas at the home. New residents had introductory visits that suited their needs and preference. This allowed them time to consider the suitability of the home. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 11 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 and 9. The care plans and risk assessments need to improve to make sure residents receive safe and consistent care. EVIDENCE: The care plans were not maintained in an orderly manner, with easy to find information; they were not designed in a format to help residents better understand the information about them. Some assessed needs had not been transferred into care plans with clear actions that staff were to take. See Standard two for examples. Each resident had a proposed package of care; this included daily activities and care needs. The proposals were positive and focused on the individual’s needs and personal development. They were clear and easy to understand. The care plans did not reflect some of the care package proposals. There were no records to explain this in the plans. One care plan set out specialist requirements, agreed by a multidisciplinary team. However staff did not follow the guidelines; they said this was because West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 12 the plan did not work. This resulted in staff providing specialist care without clear, safe and consistent guidelines. The records on restrictions on freedom and choice were insufficient; they did not follow good practice guidelines, for example the government guidelines and the British Institute for Learning Disabilities physical intervention guidelines. Some risk assessments were in place, however these could not fully reflect potential risks because the assessments and care plans did not reflect residents full needs West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 13 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): 17. Residents were offered a variety of healthy meals. Some improvements need to be made to make sure residents receive special diets in a palatable and dignified manner. EVIDENCE: This inspection did not check personal development, education and occupation, community links and leisure against the standards. A weekly menu was available, however staff said they checked with the resident’s what their choice and preferences were on the day. Residents had three meals a day, and snacks and drinks were readily available. A file kept in the kitchen contained information about resident’s preferences, special diets and what the residents had eaten. See Standard 41 for more information about the file. During a meal preparation the inspector noted that a calorific powder was poured onto a meal rather than stirred into it. The inspector asked the staff member to change this practice to make the meal more palatable and dignified for the resident. Residents were given assistance where needed with their meals. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 14 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. Residents received assistance with personal care in a dignified manner. The home needs to make improvements in the way it monitors and records health care needs, and in the recording of medication. This would better safeguard residents’ health and welfare. EVIDENCE: Staff assisted residents with personal care; the inspectors noted that the staff were mindful of the residents privacy and dignity. Staff closed doors when residents were changing; and residents received intimate care by a person of the same gender. Staff followed residents preferred times for getting up and having meals and baths. Residents’ individual preferred routines were set out in the care plans, for example assisting a resident to have a bath, or a night time routine. One care plan did not include health professionals’ details apart from the GP. Some resident’s had changing or deteriorating health needs, for example mental health needs and behaviours. The records were not clear and consistent enough to identify and monitor the changes. For example records West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 15 about how long physical interventions had taken place were confusing and inconsistent. There was no care plan to support one resident’s assessed health need. This could put residents at risk of receiving inconsistent care, not having their changing health needs clearly identified or communicated to other professionals. Standard two and six gives further examples of this. Staff who administered medication said they had received training. The medication was appropriately stored. Medication details had been hand written onto the Medicine Administration Records (MAR) chart; the chart had not countersigned to confirm the information was correct. There was no date, quantity or signature recorded on the MAR sheet for the receipt of medication. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 16 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 Residents and their families were able to raise concerns and complaints. Trained staff and accessible adult protection procedures protected service users welfare. EVIDENCE: The complaints procedure was available at the home. In the entrance hall a notice gave the commissions address without the complaints procedure. This could cause confusion if someone wishes to complain to the home direct. Staff said they had received adult protection; policies and procedures were available in the office. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 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, 26, 27, 28, 29 and 30. The home was very well and pleasantly furnished; it was comfortable and suited the needs of the residents. The cleanliness of the kitchen and the cleaning schedules need to be improved to make sure residents health, respect and dignity are maintained. EVIDENCE: The home was bright, welcoming and homely. One resident told the inspectors he was warm and comfortable and pleased with his flat. Resident’s rooms were spacious and had been personalised to meet the resident’s individual needs and preferences. The design of the toilets and bathrooms met the residents’ individual needs; they could choose between a bath and shower and toilets and bathrooms were close to bedrooms and living areas. The following was found in the kitchen: • There was food and debris on the floor and under the work station. • Unwashed roast and grill trays were stored in the oven. • The microwave had food stains on it. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 18 • • • • • The cooker hob had splashes of food on it. The toaster had not been cleaned. There were food spillages in one cupboard and in the fridge. Open food packages had been stored in the fridge and freezer without labels. Plain and chocolate biscuits had been stored in a warm place causing the chocolate to melt and the biscuits to become inedible. The inspector made the staff member present aware of these areas. The homes cleaning schedule was difficult to follow; it did not include all areas of the home, for example the laundry floor and walls. Staff signatures were inconsistent, for example there were no signatures against bathroom cleaning for at least 5 days. The staff on duty said they were aware this was a problem. One staff stated staffing levels made it difficult to maintain cleaning routines. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 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): 31, 32 and 34 Staff roles and responsibilities need to be better clarified and the recording of Criminal Record Bureau checks needs to be improved. EVIDENCE: The lead inspector was concerned that staff had not been given a clear understanding of their roles and responsibilities. This was because of the evidence found around physical intervention practices, care plan records and the cleaning schedules. The staff on duty and the manager confirmed that training and induction was provided. The inspector checked one induction booklet, this was signed by the manager only, the staff member had not signed it and no comments were made about any of the areas covered. One staff recruitment file was checked. Thorough recruitment checks had been carried out. The file confirmed that a criminal record bureau check had been completed, however it did not record the level of the check, if it included POVA and the date of the check. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 20 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): 39, 40 and 41. Policies and procedures were in place to safeguard residents’ rights and best interests. Record keeping and quality audit checks need to be improved to make sure the residents’ safety, welfare, and dignity are maintained. EVIDENCE: The provider carried out monthly visits. The reports included quality audits such as care plans and medication systems. The audit carried out before the inspection stated care plan and medication systems were satisfactory. The audits therefore could not have been measured against National Minimum Standards, Care Home Regulations and Royal Pharmaceutical guidelines. Policies and procedures were relevant and accessible to staff at all times. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 21 Some documents and records were not maintained in an orderly and secure state. For example some photocopied forms were of poor print and not copied straight, this made some of the information difficult to understand or read. The menu file contained information about residents, some of which was recorded on dishevelled paper or stored in a plastic sleeve, which was ripped and worn. Examples of other record requirements are reported in the relevant areas of this report. West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 22 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 3 2 2 3 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 2 32 2 33 X 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X X X 2 3 2 3 3 West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 YA2 Regulation 14 Requirement Care plans must be based on the residents assessed needs. This must include special and specific needs for example, the ageing process and dementia. Assessments must be dated and signed. Staff must be given further support and guidance so that they have a full and confident understanding of residents’ specialist needs. Physical interventions and the recordings must be carried out following good practice guidelines. Care plans must be maintained in a manner that is orderly and the information easy to access and find. The format of the plans must be designed to help residents better understand the information about them. Where the proposed packages of care are not being delivered, the West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 24 Timescale for action 31/03/06 2 YA3 18 31/03/06 3 YA3 13 28/02/06 4 YA6 15 31/03/06 5 YA6 13,15 reasons must be clearly documented and residents and families must be consulted. Restrictions of freedom and choice must be better-recorded using government and good practice guidelines. When it is not appropriate or safe to deliver the care stated in a care plan, the care plan must be reviewed. 28/02/06 6 YA9 13,14 Written interim guidance for staff giving clear and consistent approaches and the reason why must be put in place while the plan is reviewed. All potential risks must be 28/02/06 considered following residents assessed needs. These must be clearly documented. Dietary preparations must be prepared according to their instructions. The residents choice and dignity must be considered when preparing and serving meals. Care plans must include all related health professionals’ details. Information must be clear and consistent when monitoring and recording changes to health needs and behaviours. Two staff must countersign hand written details on medication administration records. The home’s complaints procedure must replace the commission for social care inspection contact details in the entrance hall to avoid confusion. The kitchen must be thoroughly cleaned. DS0000065298.V274409.R01.S.doc 7 YA17 13 28/02/06 8 YA19 15 28/02/06 9 10 YA20 YA22 13 22 28/02/06 28/02/06 11 YA30 13,16 28/02/06 West Street, 36 Version 5.1 Page 25 The kitchen must always be maintained in a clean and hygienic manner. Open food packages must be labelled and dated. Food must be suitably stored to preserve freshness and fitness. The cleaning schedule must be revised to make sure it can be understood and followed. Staff must be given further support and guidance about their roles and responsibilities. Records about the criminal record bureau checks must include the level, confirm POVA was included, and the date of the check. Audits including Regulation 26 visits must be measured against good practice guidelines and the National Minimum Standards. Records must be maintained in a secure and legible manner. 12 13 YA31 YA34 18 19 31/03/06 31/03/06 14 YA39 12,26 28/02/06 15 YA41 17 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA30 Good Practice Recommendations It is recommended that cleaning schedules should be monitored by the manager and during Regulation 26 visits to make sure the cleaning is properly carried out and has been signed for. Both the manager and the staff should sign the induction booklets and make comments in the appropriate sections. 2 YA32 West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 West Street, 36 DS0000065298.V274409.R01.S.doc Version 5.1 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. 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