Inspection on 13/10/05 for Westwood

This inspection was carried out on 13th October 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Westwood 12/07/07

Westwood 27/07/06

Westwood 25/04/05

Westwood 08/10/04

Westwood 30/06/04

Westwood 23/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Westwood 9 Knoyle Road Brighton East Sussex BN1 6RB Lead Inspector Elizabeth Dudley Unannounced Inspection 13th October 2005 10:00 X10015.doc Version 1.40 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 Westwood DS0000014260.V256884.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Westwood Address 9 Knoyle Road Brighton East Sussex BN1 6RB 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) 01273 553077 Mr Mohamed Saber Sadek Mrs Sadek Mr M S Sadek Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The number of people accommodated must not exceed twenty-nine (29) The residents will be aged 65 or over on admission Date of last inspection 25th April 2005 Brief Description of the Service: Westwood is a privately owned residential home, registered to provide personal care for 29 older people. The building consists of two semi-detached properties converted for its current use. Accommodation is presented across three levels, ground, first and second floors, accessed by a shaft lift. This includes seventeen single and three double bedrooms, seventeen of these 20 rooms having en-suite facilities. The home has communal facilities that include a lounge/dining room and an attractive garden that has access for wheelchairs. Situated in a residential area on the outskirts of Brighton, it is close to a main bus route and local parks. Although there are no car parking facilities at the home, all adjoining roads have unrestricted parking Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 13th October 2005 over a period of 4 hours and forms part of the inspection programme for this home. During this period of time a tour of the home was undertaken, records including medication files, health and safety, menus and personnel files were examined and 14 residents and five members of staff were spoken with. Thanks are extended to Mr Sadek, owner and manager who facilitated this inspection and to staff and residents for their courtesy and hospitality. What the service does well: What has improved since the last inspection? The home has improved their recruitment procedures and is now receiving all necessary documentation prior to staff commencing work at the home. Training files and paperwork necessary to ensure the efficient running of the home are now in place. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 6 Some areas of the home have been redecorated and some maintenance has taken place, although there is still much to be achieved. The owner/ manager appears to be more enthusiastic in his plans for the home and is applying suggestions made during inspections. The atmosphere during inspections is far more positive than previously and it is felt that the continuing improvement will be on going. A deputy manager has now been employed and will be undertaking the NVQ 4 during the next year. She appeared to be settling into her new role and it is hoped that she will be a positive force in assisting with the planning of refurbishment to the home and involved in staff recruitment and training events. What they could do better: There is room for improvement in the décor and furnishing of the home, and discussions were held with the manager on the necessity of replacing the carpets and some of the bed linen and curtains. Overall the home needs clearing of excess furniture, ornaments and general unused items, which give a cluttered feel to the home. Although cleanliness in the home is reasonably good, the worn carpets and furnishings mask this. Bed bases must be replaced with those covered in impermeable material in order with infection control recommendations; these also recommend the removal of block soap in bathrooms and communal towels and washcloths. Resident’s personal toiletries should not be left in bathrooms as these could pose a danger to other residents. Some window restrictors were seen to be broken and the owner must be vigilant in checking that these are in place at all times. All rooms should have a locked drawer facility, and residents should hold the keys to this unless they are unable to do so. Lockable doors must be provided, but residents capability to hold keys to this should be judged under the auspices of a risk assessment and records kept stating whether the resident holds the key, or does not wish to do so. Formal supervision of staff had been commenced but has been overlooked recently, and this must be recommenced. Medication administration is usually undertaken to professional standards at Westwood, however on this occasion unmarked medications were found in a pot in the kitchen and some medications had not been signed for following a medication round. The manager must address these issues with staff, as they are serious issues, which could endanger residents. The storage of medication Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 7 keys in a cupboard in the dining room must cease and the senior carer should keep these on their person at all times. An activities programme must be set up and although some activities are taking place, records of these were not complete and the range of activities were unimaginative, most of the carers have undertaken a study day to inform them of ideas for activities which would be enjoyed by this age group. 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. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 All prospective residents are assessed to ensure that their needs can be met, and are encouraged to visit before they decide to make Westwood their home. EVIDENCE: Mr Sadek, the home manager, assesses all prospective residents prior to their admission to the home. Assessment documentation used is comprehensive and the information gathered is used to form the basis of the resident’s care plan in conjunction with any assessments that take place through the social services department. This ensures that the home can meet the needs of the resident and that the resident is sure that the home can meet their needs Prospective residents and their representatives are encouraged to visit the home and meet the residents and staff before making the decision to make Westwood their home. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8,9,10 Community nurses and GP’s are contacted as needed and residents appeared to be receiving a good standard of personal care. Some areas in the administration of medication need attention to ensure resident’s safety. EVIDENCE: Whilst staff in the home deliver the personal care to residents, community nurses visit the home to give any nursing care required. It was evident that staff liaises with GP’s if necessary and will accompany residents on visits to the hospital. Some residents spoken with said that they had either seen the doctor or the nurse recently and that if they wanted to see the doctor this was always arranged for them. Mattresses and cushions for the prevention of pressure damage were seen to be in use in the home, and there was evidence that advice is received from continence advisors. A chiropodist visits on a regular basis, and opticians and dentists are accessed as required. Some members of staff have attended a course on administration of medication, however some night and early morning medications had not been Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 11 signed for on administration and the manager must address this. Staff are not retaining possession of the drug cupboard keys at all times and a method whereby this is made possible must be put into place. A pot of tablets was found in the kitchen without the residents name on it and no indication was seen in the MAR charts indicating to whom they belonged or why they were in the kitchen. Residents stated that they felt that their dignity and privacy was maintained and that they were able to see doctors and nurses in private. Visitors can be seen in their own rooms and personal phone calls can be made in the manager’s office if required. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 Residents are able to make choices around the activities of daily living. The standard of catering is good with a varied choice of food to ensure residents have a pleasing balanced menu, however the range of activities must be increased to allow residents to optimise their capabilities EVIDENCE: The majority of residents within the home were spoken with and most stated that they felt that they had choices around the main activities of daily living including times of rising and retiring. Some activities take place within the home, a musical entertainer comes in once a month and carers provide activities such as board games. However the range of activities provided is small, although staff have received formal training on the promotion of activities for the older person. Although some residents go into the garden and one resident spends a lot of time in Brighton during the day, most residents were sitting in the lounge, talking to each other and the staff. A programme of activities must be devised and put in place, and although some records are kept of activities provided to residents, this was spasmodic and not recorded regularly. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 13 The home has an open visiting policy and residents stated that they could have visitors at any time; ministers of religion visit the home although the manager states that he has difficulty in arranging for these visits. The standard of catering is good and residents said the ‘food is lovely’ and the cook knows what they enjoy. This was reaffirmed by the cook who said ‘ its difficult to please them all the time but I do my best’. Lunch served on this visit was Soup, Lamb chops, cauliflower and potatoes and fruit cheesecake. Residents said staff would make them a cup of tea whenever they want one and that staff will also bring sandwiches in the night for them. The choices of food were not apparent on the menu, but daily menu sheets showed that residents are able to choose other meals than those itemised on the menu. The menu for the day is now displayed in the dining room. The kitchen is kept very clean and there is a good range of fresh and frozen food. Fridge and freezer temperatures were seen to have been recorded on a daily basis and most staff have undertaken the food hygiene course. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Residents are aware of how to make a complaint and felt that their complaints would be dealt with in a fair manner. Staff are aware of their responsibilities towards the residents in their care and relevant checks have been undertaken by management to ensure that residents are protected by suitability of staff employed. EVIDENCE: The home has a complaints policy, which is in line with the standard, no complaints have been received by the CSCI and the manager states that any minor complaints he has received have been dealt with. Residents stated that if they feel they are not happy with something ‘ we tell Mr Sadek and he sorts it out for us’. Residents are able to see solicitors or financial advisors within the home and the manager has contacted the Money Advice Centre on their behalf. Some members of staff have now received formal training on the protection of the vulnerable adult and this training must be on going. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,2122,23,24,25,26 Efforts to improve the maintenance, décor and tidiness of the home have been made over the past year, this is on-going and must be continually addressed to ensure a comfortable home for residents. EVIDENCE: A large amount of basic maintenance has been undertaken in the past year, as has some redecoration. There is a need to address the standard of furnishing , curtains and carpets within the home and this was discussed with the manager. The garden is well maintained, and is accessible to all residents. The patio area must be kept clear of rubbish, Zimmer frames and other items, although this is much improved. The front of the outside of the house has benefited from recent maintenance. Communal areas which consist of a large lounge /dining room need some attention to give a more homely feel, and this may be gained by rearranging Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 16 chairs and tables and by attention to the amount of furniture and objects within the lounge. Chairs in the lounge are covered in impermeable fabric and in good condition although the arms of these need cleaning and further attention to ensure this is maintained. . Communal bathrooms were seen to be in clean condition and the home has sufficient bathrooms and toilets to meet the needs of the residents. Seventeen bedrooms have ensuite facilities consisting of a w.c and washbasin and those seen were clean. The home has been assessed by an occupational therapist and her recommendations have been put in place. Water temperatures have been checked on a monthly basis, although this was overlooked last month. Records show that temperatures are within recommended parameters. The majority of beds in the individual rooms need replacing and these should have an impermeable base and mattress for easy cleaning. Carpets in most rooms are also in need of replacing and some effort must be made to ensure curtains are kept on their tracks. Furniture in the rooms is in need of attention, and a rolling programme for this and other maintenance must be submitted to the CSCI. Residents are encouraged to bring in their own possessions to make their rooms more homely. Not all rooms have a lockable facility, residents may choose not to hold a key to these, but the facility must be present in the rooms. Likewise residents must be consulted over whether they wish to have a lock fitted on their bedroom door and records kept of this, keys should be given to residents within the auspices of a risk assessment. Infection control policies are in place, but some bar soap and also washing utensils were still seen to be present in a bathroom and this practice must cease. Liquid soap and disposable towel rolls were seen to be in place in bathrooms, but it would look more professional if the appropriate dispensers were to be purchased. The standard of cleanliness throughout the home was good, apart from the laundry area and the stairs leading to the staff rest rooms and laundry areas. Two rooms were malodorous and although attempts have been made to control this, present circumstances makes this difficult. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 There are sufficient staff on duty on a daily basis to meet the needs of the residents. Adequate recruitment procedures and on-going training of staff ensures that residents are in safe hands at all times. EVIDENCE: There are sufficient staff on duty to meet the needs of the residents, night staff cover consists of one waking and one sleeping carer. Four members of staff (45 )have their NVQ2 qualification with a further 2 members of staff studying for NVQ 3. All new members of staff have undertaken an induction course to the NTO standard and the manager has sent some members of existing staff on an external course to achieve this. The manager must ensure that this standard is maintained. Staff attend training relevant to their role and 5 members of staff have undertaken medication training. However staff are not receiving payment when attending training sessions if they are off duty, and the manager is reminded that staff should receive 3 paid training days per year and that staff must be reimbursed for any time spent, during their off duty hours, undertaking mandatory health and safety training. Staff meetings are taking place as are informal resident meetings. All staff files were seen to contain all documentation, including CRB checks and references and the manager assured the inspector that new staff do not commence work until these have been received. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33, 36,38 The ethos of the home provides a comfortable homely atmosphere for residents. The manager must ensure that formal supervision of staff recommences and that staff are vigilant in maintaining health and safety issues in order to safeguard the safety of the residents. EVIDENCE: The home has been owned and managed by Mr M Sadek, in partnership with his wife, for 16 years. It is evident that there is a very good rapport between the manager, staff and residents. Residents reinforced this with very positive comments about the manager, some stating they found him very helpful and kind. Mr Sadek, attends courses which have included first aid, medication and moving and handling and a requirement had previously been made for him to attend a management course applicable to his role, however due to the length of time he has been managing the home, it will be considered sufficient for him Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 19 to update on any management issues that he feels will help him in his role. A deputy manager has recently been appointed and provision will be made for her to attain the NVQ4. As she is new in post, this has not been made a requirement on this inspection. A quality assurance system, which has addressed resident’s comments, is in place and this needs to further be extended to critically assess the environment, catering and other activities within the home. All policies and procedures have been reviewed in the past year. Formal staff supervision had been commenced but has recently been overlooked and a requirement to recommence this has been made. All certificates relating to the servicing of utilities and equipment were seen, most being in date apart from the PAT testing that is due. There was evidence that staff have attended mandatory fire and moving and handling training in the past year, but fire training will be due soon and the manager is having difficult accessing a trainer following the retirement of his previous trainer. It must also be ensured that manual handling training is renewed when it becomes due. The majority of staff have the food hygiene course and 6 members of staff have a first aid certificate, again revision of these will be necessary in due course. Two window restrictors were found to be broken and these must be repaired. One of the fire doors which the fire risk assessment showed need not be used as a fire door was blocked by furniture. It is good practice to keep this as a fire door as staff and residents are aware of this, therefore the furniture should be removed. Personal toiletries must not be left in communal bathrooms to minimise the dangers of residents mistakenly ingesting or using these. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 3 3 2 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 1 x 2 Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 21 yes 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 2 2 3 Standard OP9 OP9 OP9 OP12 Regulation Reg 13 (2) Reg 13(2) Reg 13(2) Reg 16 (2)(m)(n) Requirement That all medications are signed for on administration. The manager to address the issue of tablets being left in the kitchen in unnamed pots. That a method of enabling medication cupboard keys to be kept secure is put in place. That a programme of activities is devised and regular records kept of activities provided. This was a previous requirement April 2005) That all rooms have a lockable drawer. This was a previous requirement ( April 2005) That a programme of refurbishment with timescales is sent to the CSCI That all rooms have a lockable door with keys provided to service users within the auspices of a risk assessment and records are kept of this. That carpets are replaced in most areas and that bed bases in most areas are replaced. That washcloths are removed from communal bathrooms. DS0000014260.V256884.R01.S.doc Timescale for action 13/10/05 13/10/05 13/10/05 30/10/05 4 5 6 OP24 OP19 OP24 Reg 12(4)(a) Reg 23(b) Reg 12(4)(a) 30/10/05 10/11/05 10/11/05 7 8 OP24 OP26 Reg 16(2)(c) Reg 13(3) 30/06/06 13/10/05 Westwood Version 5.0 Page 22 9 10 11 12 OP36 OP38 OP38 OP38 Reg 18(2) Reg 13(4) Reg 13(4) Reg 23 (4) That formal staff supervision is recommenced. That window restrictors are kept in a good state of repair. That all toiletries are removed from bathrooms. The manager ensures that all fire doors are kept free from obstruction. 13/10/05 13/10/05 13/10/05 13/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP26 Good Practice Recommendations That users of catheters are provided with discreet apparel to conceal their day bags and promote dignity. That soap and paper towel dispensers are put in communal bathrooms and wc’s. Westwood DS0000014260.V256884.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. 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