Care Home: Booker Avenue (98)

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What the care home does well The overall findings of the inspection were good. Booker Avenue is a small home which works on the principles of ordinary community living. Each of the people living at the home has a care plan and these describe the needs of the person in detail. People living at the home are supported to use the local community and to pursue interests outside of the home. People living at the home are well supported to remain healthy and staff have a good level of information on the people`s health needs and are supporting them to attend health appointments on a regular basis. Staff appear to have built good relationships with the people living at the home and to have gained a good understanding of their needs. Staff carry out regular safety checks so that people living at the home are provided with a safe place to live. What has improved since the last inspection? There has been an increase in the variety of leisure and community activities which people living at the home are supported with. Staff have been provided with further training since the last inspection. This has included training in first aid, food hygiene, health and safety, administering medication and adult protection. There have been some improvements to the presentation of the home and some redecoration. Two of the three people who live at the home have had their bedrooms redecorated and a number of other areas have been decorated. Staff meetings are taking place on a more regular basis. These provide staff with the opportunity to talk about the needs of the people living at the home and to look at ways to improve the service. Staff are also being provided with regular one to one supervision meetings with the manager. What the care home could do better: A copy of the complaints procedure and a copy of the adult protection procedures were not available. The manager must make sure that these are available at all times for staff to refer to. The way in which information on health appointments for people living at the home is recorded needs to be improved so that this information is more readily available. Fire alarm tests need to be carried out more frequently. CARE HOME ADULTS 18-65 Booker Avenue (98) 98 Booker Avenue Allerton Road Liverpool Merseyside L18 9SD Lead Inspector Debbie Corcoran Key Unannounced Inspection 12th December 2007 10:00 Booker Avenue (98) DS0000067108.V340091.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 Booker Avenue (98) DS0000067108.V340091.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. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Booker Avenue (98) Address 98 Booker Avenue Allerton Road Liverpool Merseyside L18 9SD 0151 524 3606 0151 524 3602 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) North West Community Services (Merseyside) Limited Claire Matthews Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th July 2006 Brief Description of the Service: 98 Booker Avenue provides care and accommodation to three adults who have a learning disability. The home is run by North West Community Services. The accommodation is a dormer bungalow and the facilities for the residents are situated on the ground floor. The home is accessible for people who use wheelchairs and the accommodation provided is spacious and appears well maintained both internally and externally. The home is situated in the Allerton area of Liverpool and is close to local amenities, bus and rail routes. The fee for residing at Booker Avenue is currently £1, 270.87 per week. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit to the home was not announced beforehand. During the visit all three of the people living at the home were met. The manager and members of the staff team were spoken with. Care plans, staff training records, health and safety records and other relevant records were examined in some detail. A tour of the home was carried out which included all areas. The manager of the home returned a quality assurance assessment to CSCI prior to this the visit and some of the information in this has been used to inform the inspection. What the service does well: The overall findings of the inspection were good. Booker Avenue is a small home which works on the principles of ordinary community living. Each of the people living at the home has a care plan and these describe the needs of the person in detail. People living at the home are supported to use the local community and to pursue interests outside of the home. People living at the home are well supported to remain healthy and staff have a good level of information on the people’s health needs and are supporting them to attend health appointments on a regular basis. Staff appear to have built good relationships with the people living at the home and to have gained a good understanding of their needs. Staff carry out regular safety checks so that people living at the home are provided with a safe place to live. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A guide to the home is available to provide prospective residents and their representatives with the information they need so as to make an informed choice about moving to the home. EVIDENCE: A statement of purpose which describes the services offered by the home is available. A service users guide is also in place. This has been produced in an easy read format and includes the use of pictures. There have been no new people to the home for many years and since the introduction of the above standards. Therefore the assessment and referrals processes could not be practically assessed. It was reported in the home’s annual quality assurance assessment that if a new person was planning on moving to the home then a full assessment of their needs would be carried out and this would include working with the person themselves, people who know the person and relevant health professionals. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each of the people living at the home has a detailed care plan which provides a good level of information on the person’s needs and how to meet these. Risks to the safety and well being of people living at the home are assessed and plans are put in place to manage these. EVIDENCE: Each of the people living at the home has a care plan and an Essential Lifestyle Plan (ELP). The plans are clear, informative and easy to follow. The plans include information on the person’s skills and needs, daily routines, likes and dislikes, health, weekly activities, communication skills and needs. When appropriate the plans include detailed guidelines as to how to support the person with aspects of their personal care and health. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 10 Essential lifestyle plans include a good level of detail to describe the choices of the person and the things that are important to know to successfully support the person. These plans provide information on the intricacies of a person’s care and provide staff with a very good level of detail as to the individual support needs of people. There was a particularly good example of an ELP which had been produced in picture format with minimal use of written text. This makes it more accessible for the person concerned. People living at the home have their care plans in a locked facility in their own room. Care plans detail the likes, dislikes and choices of the people living at the home and there were some good examples whereby staff are attempting to promote choice and inclusion through the use of pictures to enable people who have difficulty communicating to make daily choices. Risk assessments are carried out in relation to the support provided to each of the people living at the home and these were viewed. The risk assessments identify potential hazards to the person’s safety and well being and include detailed guidelines as to how to then manage the risk or prevent the risk from occurring. The risk assessments cover different aspects of the persons support. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 11 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, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are supported with their personal development and supported to pursue social and leisure activities and use the local community. People living at the home are encouraged to choose their food and meals and are encouraged to eat a healthy balanced diet. EVIDENCE: Alongside having a care plan each person living at the home has an ‘individual action plan’ and these identify a goal which staff will then support the person to achieve. The goals identified in these looked appropriate to the needs of the people concerned and were focused on quality of life issues. During discussions with staff they described some of the weekly activities which people living at the home are supported with and reported that there have been improvements in this for some of the people living at the home. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 12 Activities include supporting people with attending swimming / hydrotherapy, attending college, days out, meals out, social evenings and occasional theatre trips. One of the people living at the home is supported with a work placement. Essential lifestyle plans include a good level of information on the person’s independent skills and thus staff are clear as to how to promote and encourage these. Records relating to people living at the home include information on the people who are important to them and include contact details for their relatives, friends and relevant others. People living at the home are supported to build relationships through the use of community resources and through leisure facilities. In assessing the diet and meals available to people living at the home menu records were looked at and the availability and storage of food was checked. These indicated that the people living at the home have a good choice and variety of food and meals. People living at the home are encouraged to make choices of meals through a variety of means of communication and staff know each person’s likes and dislikes. This information is well documented as information on people’s likes, dislikes, strengths and needs regarding food, meals and eating are recorded in the people’s essential lifestyle plan. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are well supported with their personal care and their physical and emotional needs. Medication is managed safely on behalf of the people living at the home. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 14 EVIDENCE: Each of the people living at the home has a care plan and an essential lifestyle plan which include a good level of information on how to meet the person’s personal and health care needs. Each person has a ‘personal health record’ booklet and these include information on the person’s health needs. People living at the home are supported to visit a General Practitioner or district nurse when this is required and are supported to visit a dentist, optician etc on a regular basis. Some of this information is currently documented in daily reports. Because this information is being recorded in the resident’s daily care notes it is difficult to establish the frequency of visits to a range of different health professionals. It is therefore strongly recommended that a new system of recording this information is used which makes it easy to identify when a resident has last seen, for example, a Psychiatrist, GP, nurse or dentist and what the outcome of the visit was. Where a person requires support with personal care their plans include detailed information on the person’s needs, skills, choices and routines with this. Essential lifestyle plans by their nature guide staff on how to support people using the service with their emotional and psychological well being. Polices and procedure used for the receipt, storage, and documentation of medications within the home are in place. Medication storage and records were checked. These were found to be appropriate with the exception of one medication administration record which should have been signed and dated as to when a medication was discontinued. Information on medication and on the side effects of medication is maintained. Staff have been provided with medication training. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff act upon the views and wishes of the people living at the home. Practices are in place to safeguard the people living at the home, however relevant procedures were not available to guide staff in the event of a complaint or allegation of abuse being made. EVIDENCE: The statement of purpose and service user guide for the home include brief information on how to make a complaint and give an overview of how complaints are dealt with. A complaints procedure for use by people outside of the home was not available. The manager reported that NWCS did have a complaints procedure. The manager agreed to attain a copy and to forward a copy to CSCI following the inspection visit. A copy was forwarded following the visit. The manager must ensure that a copy is available at the home. Staff appear to know the needs of the people living at the home well and this therefore indicates that they are aware of people’s needs and choices and listen to people when these need to be changed. There have been a number of complaints made since the last inspection visit. These have been recorded, investigated and responded to. The nature of these complaints was looked at and none of the complaints made raise any particular concern. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 16 The home has a ‘whistle blowing policy’ the purpose of which is to protect staff who identify and report allegations of abuse. There was copy of Liverpool Social Services adult protection policy available at the home. However, there was no NWCS adult protection policy or procedure available. This should be in place to guide staff as to how to respond to an allegation of abuse. The manager reported that there was an adult protection policy but a copy of this was not available on the premises. The manager agreed to attain a copy and to forward a copy to CSCI following the inspection visit. A copy was forwarded following the visit. The manager must ensure a copy is available on the premises at all times. Where a person living at the home requires support with managing their money then a record of all transactions is maintained. These are audited on a regular basis by the manager, also by an area manager and by personnel at the head office. The records were looked at for one of the people living at the home. The records were being kept appropriately, however the manager was requested to clarify the system for transferring money into the bank accounts on behalf of the people living at the home. A record of key events is maintained for example incident reports and accident reports. These were checked and found to be maintained appropriately and there were no areas of concern identified. Booker Avenue (98) DS0000067108.V340091.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, 27, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with safe, clean and comfortable accommodation Health and safety precautions are taken to protect the people living at the home and staff. EVIDENCE: A tour of the premises was carried out which included most areas. The home is an ordinary domestic property. The home feels spacious and there are nice gardens areas both at the front and rear. There is one lounge area, a dinning area and a chill out room which is a light and sound room. Each of the people living at the home has their own bedroom. Two of these were viewed and found to be well presented and personalised with people’s own belongings. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 18 The home has aids, adaptations and equipment to meet people’s needs. However, the bath is not fitted with a hoist to enable two of the people living at the home to use it. The manager is attempting to address this. Equipment is serviced on a regular basis. The home has health and safety practices and procedures aimed at ensuring the home is safe, clean and free from hazards to the health and safety of people living at the home and to staff. Booker Avenue (98) DS0000067108.V340091.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are supported by trained and qualified staff who receive regular support. Staff appear to know the needs of people and their likes and dislikes well and staffing levels allow for a good level of one to one support for people. EVIDENCE: Two members of staff work at the home throughout the day and when activities are planned for people then additional staffing is provided. Staff training records were examined. These showed that staff have been provided with training in topics such as health and safety, food hygiene, protection of vulnerable adults, first aid, moving and handling, supporting people with specific health needs. The manager has carried out an analysis of staff training and planning is in place to meet the identified training needs of staff and to ensure that staff are provided with training in core health and safety related skills. There was little evidence of staff training in topics relating specifically to the needs of the people using the service. It is recommended that this is provided. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 20 There are 11 members of staff employed at the home and of these 6 have attained a National Vocational Qualification (N.V.Q) level 2 in care or above. A further two members of staff were reported to be in the process of attaining the award. Discussions with members of the staff team indicated that staff are supporting the aims and objectives of the home in encouraging the people living at the home to make choices and use their local community. Three new members of staff have commenced employment at the home since the last inspection. The recruitment and selection procedures used when employing these members of staff were checked so as to ensure that procedures protect people living at the home. The actual hard copies of staff recruitment information is held centrally at NWCS head office but written and signed confirmation of this was available in the home. This is as agreed with CSCI. Staff are being provided with the opportunity of regular supervision meetings and records showed that team meetings take place on a regular basis. These provide staff members with a regular forum to discuss issues that may affect the service provided to people living at the home, to discuss service development and the implementation of polices, procedures and practices within the home. Booker Avenue (98) DS0000067108.V340091.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, 38, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the people using the service. The quality of the service is checked on a regular basis. Policies, procedures and practices are in place to safeguard the safety and well being of people living in the home and staff. EVIDENCE: The home has a manager who is registered with CSCI. The manager has introduced some good practices and is actively planning to ensure the service meets the needs of the people living at the home. The manager promotes person centred care and ensures there is planning to increase the opportunities for new experiences for people living at the home. Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 22 The home appears to be run in the best interests of the people living at the home. There is a quality assurance process at the home which includes regular visits and audits from a representative employed by NWCS. Staff are provided with training in health and safety topics and the home has health and safety policies and procedures. Fire safety and health and safety practices are adopted. Records of fire and health and safety checks were checked and found to be up to date with the exception of fire alarm tests which should be carried out more frequently. Booker Avenue (98) DS0000067108.V340091.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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 2 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 3 x Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13 (6) Requirement A copy of the complaints procedure and the adult protection procedure must be available so as to guide staff and safeguard the people living at the home in the event of a complaint or allegation being made. Fire alarm tests must be carried out at appropriate intervals. Timescale for action 12/01/08 2. YA42 23 (4)(c) (v) 12/01/08 Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 25 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 YA19 Good Practice Recommendations The manager should review the current system for recording when a resident has been supported to see a health professional or any other health related matters. Medication administration records should be accurately maintained at all times. The manager should clarify the system for transferring money into the bank accounts on behalf of the people living at the home. The bath should be fitted with suitable equipment so as to enable people living at the home to use it. Staff should be provided with the opportunity of more specialised training in relation to the needs of the people living at the home. 2. 3. YA20 YA23 4. 5. YA27 YA35 Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 Booker Avenue (98) DS0000067108.V340091.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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