Care Home: Beech Tree Hall

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What the care home does well Staff were well trained to meet peoples needs, there was good interactions between staff and people who use the service in various settings. The service provided, promoted and encouraged development of social and practical skills, with a range of social, educational and recreational opportunities in keeping with their ages. All people using the service were involved in some form of day care provision, and a range of activities, this was confirmed when speaking to people who use the service. Management and staff said they were working hard to improve standards to ensure that people using the service were well cared for and protected and enjoyed a fulfilling lifestyle. Care plans showed that people`s health was monitored and access to health care facilities was available, this ensured that staff had support from other health care professionals. Most people were offered an annual holiday and contact with families was supported and maintained, with some having regular home visits, especially holiday times throughout the year. Advocacy services were available and were used on a regular basis. What has improved since the last inspection? All the issues raised on the last inspection had been addressed for example, an improvement in general maintenance and refurbishment of the premises. What the care home could do better: Ensure that people`s contracts that state terms and conditions are updated as soon as possible. Continue to support staff to ensure there is a minimum ratio of 50% of staff trained to NVQ Level 2 or equivalent as soon as possible. Quality monitoring of the care and services that are provided by the home via questionnaires being sent out to parents, relatives and stakeholders to gain their view on the services provided. CARE HOME ADULTS 18-65 Beech Tree Hall Marsh Lane Arksey Doncaster DN5 0SQ Lead Inspector Janet McBride Key Unannounced Inspection 12th December 2007 10:30 Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 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 Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 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. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Tree Hall Address Marsh Lane Arksey Doncaster DN5 0SQ 01302 875001 01302 822959 beechtreehall@btconnect.com None Mr Donald Smith 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) Post Vacant Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The accommodation to include four separate units for four service users in each unit. Up to 8 beds can be used for young people aged 16 and 17. Date of last inspection 11th January 2007 Brief Description of the Service: Beech Tree Hall is registered to provide residential care and accommodation for 16 places for young adults with Autistic Spectrum Disorders, and caters specifically for adults affected by Asperser’s Syndrome. The home is located in the village of Arksey on the outskirts of Doncaster. Accommodation is provided in one of four units, which are Oak House, Holly House, Birch House, and Elm House. The first three are located on the ground floor, each with its own front door and access to the gardens at the rear of the home. Elm House is located on the first floor. Fees range from £1242:20- £2171:83 as of December 2007. Additional charges are made for some toiletries, hairdressing, newspapers and magazines. Personal items and some activities. For further information contact the service. Information about the service was available for people and their families in the Statement of Purpose and the Service User Guide. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this Key Unannounced Inspection, which took place on the 12th December 2007 for six hours. The home is registered for sixteen places, at the time of inspection all places were full. Prior to the inspection the manager submitted an Annual Quality Assurance Assessment this gives information regarding the home and services provided. Pre-inspection work was carried out on the information received and other relevant documentation, for example analysis of statutory notifications and complaint records. During the inspection, documentation and records were examined, for example medication, complaints, accident records, staff rotas and staff training files. Two care plans were cross-referenced with other relevant documentation relating to those people who use the service, to evaluate how well their care needs were met. A tour of the premises and direct observation of staff interaction with people who use the service was carried out throughout the visit. Information was gathered from as many different individuals as possible that had contact with people within the home, including individual interviews with the manager and six members of staff. Two people within the home who receive the service were also spoken to. We sent out surveys prior to the inspection, four were sent to relatives, two were received back, four were sent to professionals who had contact with the home none were received back. They were asked to comment on the standard of care, staff skills, attitude, and how the needs of people using the service needs were met. We would like to thank all the staff, relatives and people receiving services within the home for their co-operation in the inspection process. Any issues or concerns that were raised were discussed with the manager at the end of the inspection. What the service does well: Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 6 Staff were well trained to meet peoples needs, there was good interactions between staff and people who use the service in various settings. The service provided, promoted and encouraged development of social and practical skills, with a range of social, educational and recreational opportunities in keeping with their ages. All people using the service were involved in some form of day care provision, and a range of activities, this was confirmed when speaking to people who use the service. Management and staff said they were working hard to improve standards to ensure that people using the service were well cared for and protected and enjoyed a fulfilling lifestyle. Care plans showed that people’s health was monitored and access to health care facilities was available, this ensured that staff had support from other health care professionals. Most people were offered an annual holiday and contact with families was supported and maintained, with some having regular home visits, especially holiday times throughout the year. Advocacy services were available and were used on a regular basis. What has improved since the last inspection? What they could do better: Ensure that people’s contracts that state terms and conditions are updated as soon as possible. Continue to support staff to ensure there is a minimum ratio of 50 of staff trained to NVQ Level 2 or equivalent as soon as possible. Quality monitoring of the care and services that are provided by the home via questionnaires being sent out to parents, relatives and stakeholders to gain their view on the services provided. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 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 Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 &2. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People who use the service had information about the home and services provided. People were individually assessed prior to admission to ensure their needs would be met. EVIDENCE: People were provided with information about the service and care they would receive in an appropriate format. People had contracts setting out the service provided, however the manager said these need updating. Care plans showed that people within the service had been assessed before moving into the home. People wanting to use the service were introduced into the home at a slow pace taking into account background history of the person, risk assessments and a detailed plan of care that reflected any specialist interventions. Parents and families were encouraged to visit the home and ask questions. The scale of charges was discussed with the manager and any extras that people pay for, are documented on page five of this report. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 &9. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Care plans provided staff with sufficient information to meet the needs of people who use the service. People were assisted and supported by staff to make decisions and choices about all daily living needs. EVIDENCE: Two care plans were checked and discussed with key workers. Care plans set out in detail healthcare, personal and social care needs in an individual plan of care. Records showed that staff monitored and reviewed peoples changing needs. All care plans addressed any impairments brought about by their autistic condition, for example the absence of an inability to imagine and think laterally Some people did not have any social skills, therefore at times could display difficult behaviour, which staff need management so that everyone’s welfare was protected. Staff supported people to make decisions, communicate and behave appropriately at the correct level. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 11 Some people had a higher level of ability and were able to express wishes and make choices. People said they were encouraged and supported by staff to make decisions about everyday tasks. Advocacy services were available and were used on a regular basis. People were supported in taking risks as part of their daily living to enable them to be as independent as possible. One person said they went out shopping independly once a week. Limits were only imposed where risks were identified, for example having no awareness of the dangers that sharp objects bring, unawareness of hot and cold-water differences. Appropriate psychiatric input and continued support, was evident as the home had the services of a psychiatrist specialising in Autistic Spectrum Disorders. Therefore service users were reviewed on a regular basis; staff had support for to refer to when needed. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 &17. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The service provided, promoted and encouraged development of social and practical skills. This ensured that people had the opportunity to participate in leisure activities and live as part of the community. People were offered a wholesome and appealing balanced diet with a varied selection of food available to meet people’s tastes and choices. EVIDENCE: People had the opportunities to develop practical life skills and social skills and make the most of their abilities. Daily routines within the home were flexible and individual, for each person who uses the service. Activites were arranged for each individual as part of their care plan, group activities were also available. Everyone had access to a day centre owned and operated by the owner of the home. Two people said they go to collage for art and craft and some go for drama. People are supported to be part of the community, people spoken to Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 13 said they use the community facilities at a nearby village for art and craft on a weekly basis. People were supported to maintain family links and had the opportunity to meet people and make friends. They also met with people who had the same disability at different venues. Most people had an annual holiday unless they specifically chose not to go. People’s nutritional needs were assessed, with some people having the input of a dietician and all were weighed on a weekly basis. This ensured that nutrition and weight was monitored and reviewed on a regular basis. Staff promoted a healthy and nutritious diet, menus seen showed that most people followed a healthy eating plan. People who were capable helped prepare food and cook meals, some made their own packed lunches. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People’s health is monitored and arrangements for dealing with health issues were met with support from health professionals. Medication policies and procedures were well managed ensuring the safe administration of medication. EVIDENCE: Care plans showed that people’s health was monitored and staff had access to health care facilities, such as dentist, optician and any relevant specialists that were necessary, for example psychology, speech and language therapy. People continued to have the input of a psychiatrist specialising in Autistic Spectrum Disorders, who visited the home to monitor medication and review mental health problems for all people using the service. Records clearly showed that people were assisted and support by staff to make decisions and choices about all daily living needs. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 15 Detailed information of peoples personal care needs was recorded, this also included people’s wishes and preferences, or when staff provided personal support in daily routines. Staff were able to describe care needs of each person, and were aware of any restrictions on privacy, for example danger when bathing alone. Risk assessments were in place to identify any risks and how they can be managed. Records are maintained of current medication for all people within the service. Records were checked and found satisfactory with good recording systems in place. Staff who administer medication had completed accredited medication training and were familiar with each individuals preferred way of taking medication, no person administered their own medication. When people went on home leave they take the original pack, and staff recorded what medication is taken home with them. Medication is checked when they return to the service this ensures their safety and protection. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The complaints procedure was accessible and displayed within the home. Policies and procedures were in place on adult protection, this promoted and protected people who use the service. EVIDENCE: There was a comprehensive complaints procedure, this was in an appropriate format and was accessible to people. Complaint records showed no complaints had been received in the past year. The manager said they try to deal with any minor concerns or issues when raised by either people using the services or parents. Policies and procedures were in place regarding the protection of vulnerable adults. All staff had checks completed before being employed for example Criminal Record Bureau (CRB) Protection Of Vulnerable Adults (POVA) checks. One adult protection issue was raised early in the year, records showed that this had been recorded, responded to and investigated in an efficient and thorough manner. This concern was not upheld when investigated. Staff confirmed they were aware of protection polices and procedures, they were able to describe the action they would take on receiving any allegations. This ensured people who use the service were safe and protected. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26 & 30. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People who use the service live in a comfortable and wellmaintained environment. The home was clean and tidy and provided a safe environment for people. EVIDENCE: A tour of all the units found all communal areas to be clean and tidy. Each unit had a range of safe and accessible accommodation. People who use the service cannot wander freely from one unit to the other as this invades the space and privacy of others. Shared space included outside areas, and people had unrestricted access to this area. Because of the needs of people the furniture and fittings required ongoing refurbishment, all areas were found to be comfortable and homely, one lounge had a fish tank and pieces of art that people living in that unit had done in art classes. This helped to make it more homely and provide a sense of ownership about the environment they lived in. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 18 Each person had a single bedroom, their bedrooms were decorated and furnished to their own choice, some individuals choose minimal furnishings and décor. Others had more elaborate décor this promoted their right to choose and express their own personalities. A new maintenance man had been appointed, who carries out general maintenance to the home, when staff highlight any repairs or problems. This visit found an improvement in this area and any identified issues raised on the last inspection had been addressed. Laundry facilities remain the same, facilities are on site in a central laundry and staff on each unit is responsible for either helping people complete this task or ensuring peoples laundry is done. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 &36. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. A stable staff group ensured continuity of care by staff that know the people who use the service. Staff had the skills and knowledge to fulfil their roles. Recruitment policies are followed ensuring the safety and protection of people who live at the home. EVIDENCE: Staffing and management structure was discussed with the manager, who said that staff hours were determined according to the assessed needs of people who use the service, for example some people require 1:1 staffing ratios, at times. Extra staff were used when needed, if people require more monitoring, or when certain activities are being organised. The home had a stable staff group, and comments from parents confirmed that the home had very little turn over in staff. There were recruitment and selection procedures including an equal opportunities policy. All the required employment checks had been undertaken prior to staff being employed, including Criminal Record Bureau (CRB) Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 20 Protection Of Vulnerable Adults (POVA) checks. This ensured people who use the service were safe and protected. Development and training records were checked and discussed with staff. These showed what qualifications staff had achieved for example a number of staff had achieved National Vocational Qualification level 2 in care (NVQ) some had done Learning Disability Award Framework (LADAF) courses. These records also showed when staff had completed mandatory training and refresher training. Staff spoken to confirmed they are encouraged to develop their skills, feel they were supported and received supervision on a regular basis. They also said training and development and any care issues were discussed within supervision sessions, and in team meetings, which are held monthly with written minutes taken. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 &42. People who use the service experience Good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Overall management of the home was good, with policies and procedures in place to protect and safeguard people who use the service. EVIDENCE: Since the last inspection a new manager is in post and is going through the registration process. She had completed the registered managers award, and is currently completing an Open University course in Autism Spectrum Disorders. The manager said she had an open door policy and hoped she created an open and transparent atmosphere within the home. Those staff spoken feel the manager is very supportive and encourages them to complete training for their development. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 22 Quality assurance systems were in place to monitor some aspects of the quality of care and services within the home, for example care plans and medication procedures. The manager said she would be sending questionnaires out in the new year to parents, relatives and stakeholders to gain their view on the services they provide. The owner continued to carry out monitoring visits, and complete regulation 26 reports. These state what he found during his visit and who he spoke to, all were available at the home. The home employs the services of Lloyd’s employment Law and Health and Safety, who visit the home, carry out audits and make recommendations if required. The annual quality assurance assessment gave information regarding the maintenance of equipment, it stated this all had been serviced and maintained, which was confirmed by the manager. Fire safety procedures were in place, records examined showed they were current and up to date. This keeps people living and working at the home safe. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 23 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard YA1 YA32 YA39 Good Practice Recommendations Contracts that state terms and conditions should be updated. A minimum ratio of 50 of staff must be trained to NVQ Level 2 or equivalent as soon as possible. Quality monitoring systems should be in place, to seek the views of service users, parents and stakeholders to measure success in achieving the aims, objectives and statement of purpose of the home. Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Beech Tree Hall DS0000008012.V355699.R01.S.doc Version 5.2 Page 26 - 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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