Inspection on 28/07/05 for Winchley Home

This inspection was carried out on 28th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Winchley Home 27/02/07

Winchley Home 10/12/05

Winchley Home 21/12/04

Winchley Home 26/07/04

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

CARE HOMES FOR OLDER PEOPLE Winchley Home Rectory Lane West Winch Kings Lynn PE33 0NR Lead Inspector Chris Handley Announced 28 July 2005 9.30am 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 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. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Winchley Home Address Rectory Lane West Winch Kings Lynn PE33 0NR 01553 841582 01553 842270 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Gemini Care Limited Mrs Gina Reeve Care Home 41 Category(ies) of Dementia - over 65 (10) registration, with number Old age (31) of places Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home is registered to accommodate forty-one (41) Service Users in total of whom ten (10) may be Older People with Dementia. The remaining Service Users can be Older People not falling into any other category. Date of last inspection 21 December 2004 Brief Description of the Service: Winchley Home is a registered care home providing care for 41 people, 10 of whom have dementia. There are 31 single rooms and 5 double rooms. The home is maintained to a high standard both internally and externally. The home has pleasant views over the front garden. There is good access to the home, which has a large car park at the front of the home. The gardens are a feature of this home. The home receives its nursing and medical care from the local Health Centre. The home is located in the village of Winchley situated on the A10, four miles from Kings Lynn. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection and formed part of the annual inspection programme. The inspection commenced at 9.30 am and was completed at 3.30 pm. Preparatory work had been undertaken. There were 38 residents in the home. Six residents were interviewed and later provided with CSCI information cards. Two residents with their relatives in the unit were briefly spoken to. Six members of staff were spoken to. No comment cards from service users or relatives had been received, although these were sent in advance. A tour of the home of the home was made and several residents’ rooms were inspected. The Manager was present for the whole inspection. What the service does well: Good information is provided to prospective residents. Assistance is provided to residents and relative should they need any help in understanding the contract. The environment is nice, clean and tidy. The grounds are well maintained and form a feature of this home. There is a good quality of personal care. The residents’ rooms are of a good quality. The home provides good catering services. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 8 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 standard(s) 1,2, 3 Prospective residents are provided with a statement of Purpose, and Service users guide. All residents are provided with clearly set out written contracts. Pre-admission assessments are undertaken on all residents. EVIDENCE: The residents are supplied with a Statement of Purpose and Service Users Guide according to the manager. The documents seen, did not contain residents’ views of the home, and a requirement is made concerning this. All residents are supplied with Terms and Conditions the Manager said. The Manager goes through this document with the resident/relative if needed, to ensure their understanding. The resident is provided with a copy, and a signed copy is kept in the office. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 9 Pre-admission assessments are carried out on all residents prior to admission to the home. These assessments are carried out either by the Manager or Assistant Manager to make sure that the home can meet the needs of the prospective resident. The Inspector was shown a comprehensive assessment document. The home has undergone a major change in documentation and this assessment is part of this. All staff carry identification when they carry out these assessments. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,&11. All residents have an individual care plan. The residents’ health care needs are met. The medication system is effective. The home ensures that at the times of their death residents, and families are provided with appropriate care and comfort. EVIDENCE: All residents have an individual care plan. These care plans are new to the home and have only been introduced this year. Prior to their introduction training was provided to staff. All the records are clearly marked confidential and are stored securely. In the plans seen there is an assessment, plan, implementation and review. There is a good range of assessments documentation, including a weight record, a record of when the District Nurse/Doctor visits. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 11 The plan, what needs to be done, and the implementation who is to take the action required, are poorly defined, and there is no mention of residents and or relatives being involved in reviews in the documents seen. These plans are used for both groups of residents cared for in the home. It is recommended that the elements planning, implementation and review be improved, and provide clear information in each section which can be actioned by staff so that they know what care is required. It is recommended that Person Centred Approach type of Care Plans should be used for people with Dementia. The staff of the home, who have been trained in these maters, provide personal care and oral hygiene. There are no residents who have pressure sores at present the Manager said. All residents are registered with a G.P. Care needs are met by a wide range of professionals who visit the home. Based on what the Manager said the home enjoys a good working relationship with these people, and services and equipment are speedily sent/provided to the home. If needed a resident would be referred to a consultant via the G.P. The Tissue Viability Nurse, the Incontinence Advisor, CPN, Psycho geriatrician visit the home on a regular basis. Dental, Optical, Chiropody and Auditory services are obtained speedily. A wide range of equipment including special mattresses can be obtained via the district services. Based on what the Manager said the home receives a good service form the community services. The medicines are kept in a locked trolley, which is locked to the wall, in a locked room. The home has a Monitored Dosage System. This system is relatively new to the home and all staff who administer medicines have received certificated training. The Manager is soon to attend an update for Managers/Seniors who administer medicines. The home has the good practice of having a copy of Home Guide to Medication, which is a useful referral book on medicines. The cassettes were neat and tidy. Medication is neatly recorded and medicines are regularly reviewed. At present there are Controlled Drugs in use at the home, one of which was counted and found to be correct against the register. At present the Controlled Drugs are kept in a metal cupboard which is locked but the Inspector requires that they be kept in a dedicated Controlled Drug cupboard in order to meet Standard 9, 9.5. The home has a medicine procedure. The Manager is aware of the importance of the reception, storage, administration, and disposal of medicines. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 12 Care and comfort are provided to the dying resident, and good support is provide to relatives, the Manager said. Families may stay at such times and they are provided with refreshment. The wishes of the dying resident and relatives are followed at the time of death. Pain relief is provided if needed. Privacy and dignity are particularly provided at these times. The spiritual rights, and wishes of the dying person are followed. The body of the resident who has died is handled with dignity, and time is allowed for family and friends to pay their respects. Senior staff support more junior staff who may not have experienced death before. Some staff have attended the Funeral/Crematorium Awareness training which has provided a good insight as to what takes place at such times. The home has written procedures for care of the dying. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12 & 15 Residents have a wide range of choice in this home. The home provides a good catering service. EVIDENCE: The residents have a wide range of choice which includes the times of getting up and going to bed, choice of meal, choice of having a bath or having one’s hair done. The residents have the choice of bringing in personal ornaments and possessions. There is an activities letter which details the activities to be provided, and in this manner they can choose whether or not they attend Residents handle their own money for as long as possible. Residents are advised on how to contact external agents who will act in their interest. Residents have access to their own records if they wish to do so. The menus were seen and they appear varied, nutritious, and interesting. Special diets are provided but a Gluten free diet is not recorded and it is required that it should be. At present there is a choice for the main meal but this is not actively promoted. The residents interviewed spoke very well of the catering provided by the home. It is recommended that the second meal which forms the choice should be on the menu choice sheet. If needed the Manager would seek advice from the Dietician. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 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 standard(s) 16,17 &18 The home has a complaints procedure which is known to residents and staff. Residents legal rights are protected. Staff are aware of the importance of being alert to the possibility of Adult Abuse. EVIDENCE: The home has a complaint procedure which is in large print, which makes it easy to read. This document is posted up around the home. There have been no complaints since the last inspection the Manager said. The home has a dedicated record complaint book. The Manager is aware of the process to be used should a complaint arise. A client satisfaction form relating to complaints used by the company was seen. The residents interviewed were aware of what action to take if they had a complaint to make. Staff interviewed were aware of the complaints procedure. The Manager would facilitate legal advice if it were needed. A number of residents used their postal vote the Manage said, whilst some went down to vote at the polling station. There have been no incidents of abuse since the last inspection the Manager said. Staff have been trained in the prevention of Adult Abuse, the Manager said. When interviewing staff they gave the Inspector the impression that they were aware of the seriousness of this matter and that if they had any concerns they would inform the Manager. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 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 standard(s) 20 &,24, The home has a good provision of communal space. Residents’ rooms are of a high quality. EVIDENCE: There is a wide range of communal space which consists of the new lounge/dining room, the large lounge/dining room in the old house, a small lounge, and small sitting room in the old part of the house. The newly completed wing for people with dementia also has a lounge/dining room. These areas have good natural light and are in a good state of decoration, and provide pleasant areas for resident to sit and relax or to take their meals. There are also very pleasant sitting out areas at the front of the home with garden benches and ornaments. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 16 The Inspector noticed that the large lounge/dining room in the new wing was cold and the Inspector raised this mater with the Manager who informed him that there were overnight heaters in that room and that they had been some problems with this of late. The Inspector recommends that the heating system in this room be attended to so as to ensure that the room is comfortably warm when used by residents. Whilst touring the home the Inspector noticed that the decoration of the corridors in the new wing which have not been redecorated for some time, appeared dull and tired and he recommends that the corridors be redecorated and made brighter. The Manager informed the Inspector of some proposals to improve the environment in the old part of the home and she said that she would put this in writing when the proposals have been more developed. The area concerned was adjacent to the entrance to the new wing. Six rooms were seen by the Inspector. These rooms are of a high standard, they are in a good state of decorated, they are clean and comfortable and have good natural light. The residents have personalised their rooms with pictures ornaments and other personal mementoes. The residents spoke well of their rooms. There are five double rooms two of which are used as single rooms, and the remaining 3 rooms used as doubles and have privacy curtains. All rooms have call bells and fire alarms the doors are fitted with locks but few choose to use them. The Manager said that the home has a programme of replacing mattress, which ensures that they are all in good condition. The mattresses are nylon coated and they can easily be cleaned. All windows have restrictors in place. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28, 29, & 30 The home has the staff to meet the residents’ needs. The home has a programme of NVQ training in place. The home has recruitment practice in place. Some staff are trained to do their jobs, but this is not sufficient to say that all staff are trained. EVIDENCE: The off duty shows that there are 6 care staff, 3 domestic staff, and 2 kitchen staff, on a full days shift, 7.30 – 5.30, and there are 5 care staff on between 5 – 10pm, and 3 night staff, this was confirmed by the Manager. The Manager works a straight day shift. The Manager is permitted to bring in additional staff if required. During the process of the Inspection it was obvious that the staff enjoy very friendly relationships with the residents, and they informed the Inspector that they enjoyed working at the home. The home has an NVQ programme in place. At present there are 4 staff who have NVQ II, 4 who have nearly completed NVQ2 , and another 6 are to commence NVQ II in Sept. There is one member of staff who is going to undertake Team Leadership NVQ. At present the home has 33 care staff which means that there is 12 of staff have NVQ, but this figure will soon increase as the training plan develops. This is nowhere near the standard of 50 of staff having NVQ level 2 or its equivalent. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 18 The Manager described the company’s recruitment practice. All posts are advertised both in local papers and in the job centre. Application forms are sent out. Interviews are arranged, there are always two members of staff undertaking the interviews. The interview is carried out against a checklist. Police and POVA checks are carried out. Successful applicants are provided with a copy of the GSCC Code of Conduct and with terms and conditions. There are no volunteers in the home. With regard to the POVA checks these require a history to be provided. A small number of staff who have arrive in this country, have not been here sufficiently long enough period. The Manager appreciates the importance of this matter, and before the inspection ended the Manager had contacted the Employment Agency to send her new forms and advice on this matter. Which was that those who had not been fully POVA checked must be supervised at all times when at work. The practice of this home is that all new staff work accompanied by a senior member of staff. As this matter is of great importance it is a requirement. The home has Induction and Foundation training programme in place which meets NTO specification. Other training provided includes Fire Prevention, Moving and Handling, First Aid, Infection Control, Diabetes Awareness, Funeral Awareness, Food Hygiene, Care Planning training, Communication and Confidentiality Adult Abuse, Health and Safety, Equal Opportunities, Rights and Responsibilities. One member of staff is undertaking an advance course in Food Hygiene. The Manager has commenced undertaking the Certificate in Care Practices, which she hopes to complete before the end of August. There are ten members of staff who had undertaken training in Dementia Awareness. Staff interviewed were pleased with the training which they had had. It can be seen from the above list that a wide range of training is provided, and to further broaden this the Inspector recommends that a number of staff undertake training in Care for the Elderly. The home is establishing good practice in this matter but there is a way to go before the National Minimum Standard is met. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35 36 37, & 38 The Manager is fit to be in charge of this home. The home has a Quality Assurance system in place. Residents’ financial interest are safeguarded. A programme of staff supervision is in place. Residents’ rights are safeguarded by the home. The health and safety of residents is protected. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 20 EVIDENCE: The Manager has worked at this home for 19 years and has been Manager since 1997, having been Assistant Manager for 6 years. She is responsible for this home only. The Manager has a job description which was seen by the Inspector. The Manager undertakes periodic training and has recently completed Registered Managers Award. There are clear lines of authority within the home and she is responsible to the Managing Director for the day to day Management of the home. Based on her dealing with both residents and staff it is clear that she enjoys a good relations with both groups. The home uses the Company’s Quality Assurance system in which regular audits are carried out and forwarded to the Companies headquarters to ascertain the continuance of good practices. The Manager said that the company were making enquiries about ISO 2000. The Manager takes supervision for staff on a regular basis, which is recorded, a copy of which was seen. The topics covered are aspects of practice, philosophy of the home and career development. Staff spoken to said how useful they had found supervision. The home holds money on behalf of 17 residents. The monies are kept in separate containers along with an account. This is then kept in the safe and only the Manager and senior members of staff have access to this. One of the contents of a containers was counted and found to be correct against the record. Numbered receipt are provided when monies are handed in. The home has a written policy on this matter. A wide range of records were seen during the process of this inspection, and they are kept secure. Residents have access to their records. All the elements of Standard 38 were gone through item by item and the home has all the documentation required. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION x 3 x x x 3 x x STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 x 3 3 3 3 Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 22 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. 2. 3. 4. 5. Standard 1 9 29 15 Regulation 5 13 .2 Sched 2 16 Requirement it is required that residents views are contained in the Service Users Guide It is required that the home have a designated Controlled Drug Cupboard. It is required that all staff have a POVA check in keeping with up to date advice. It is required that special diets (Gluten Free) are recorded. Timescale for action 1 month Within 6 weeks Immediate Immediate 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 7 Good Practice Recommendations It is recommended that the elements of planning, implementation and review of the care plans be more specific, and that residents and relatives are involved in reviews. It is recommended that Person Centered Approach type of care plans be used for residents who have Dementia. It is recommended that the heating in the dining room in the new wing, be attended to, so as to ensure that residents can enjoy their meals in a comfortably warm I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 23 2. 20 Winchley Home 3. 4. 5. 6. 7. 8. 20 30 15 28 room. It is recommended that the corridors in the new wing be decorated with a view to brightening them. It is recommended that a number of staff undertake training in care of elderly people. It is recommended that the menu contain both menus for the main meal. It is recommended that the NVQ training programme continue. Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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 Winchley Home I55 S27342 Winchley Home V233816 280705 Stage 4.doc Version 1.30 Page 25 - 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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