Care Home: Butterfly`s

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What the care home does well Butterfly`s offers a high standard of care to those living at the home, with a range of meaningful activities on offer. Butterfly`s has a well-trained staff team that works well to support the people living at the home. The home was well managed and people living their spoke well of the home and were comfortable with the Manager and the care staff on duty. Every person living at Butterfly`s had their own bedroom and each person`s bedroom was furnished and decorated to their own taste. The communal areas were well decorated and provide sufficient shared space for in-house activities. During the visit to Butterfly`s, people living at the home and staff were spoken with. All were positive about the home and the people living there appeared at ease and were happy to talk to the Inspector. Interactions between staff and the people living at Butterfly`s observed during this inspection were positive. All people living at Butterfly`s had planned programmes of activities throughout the week and had good access to community facilities. What has improved since the last inspection? This was the home`s first unannounced inspection visit since it was registered in 2008. CARE HOME ADULTS 18-65 Butterfly`s 186 Wivenhoe Road Alresford Colchester Essex CO7 8AH Lead Inspector Neal Cranmer Unannounced Inspection 26th August 2008 09:00 Butterfly`s DS0000071469.V370592.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 Butterfly`s DS0000071469.V370592.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. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Butterfly`s Address 186 Wivenhoe Road Alresford Colchester Essex CO7 8AH 01206 826872 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) Mr Manus Webster Mrs Julie Elizabeth Webster Kay Williams Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Mental Disorder - Code MD The maximum number of service users who can be accommodated is 3 2. Date of last inspection First inspection since registration. Brief Description of the Service: Butterfly’s is a small home, registered to meet the needs of up to 3 younger adults with learning disabilities. Situated on the outskirts of Colchester, the bungalow offers three single en-suite bedrooms as well as sufficient communal space. The home is on principal public transport routes for easy access to central Colchester and is within walking distance of local shops. Fees for residing in the home are £1036.11 base line, any additional charges are based upon assessed need for additional 1.1 hours if required. No additional charges are made for any other items. This information was provided by the home’s registered manager during a telephone conversation on the 23rd of September 2008. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This report follows a key inspection of Butterfly’s that included an unannounced visit to the service on August 26th 2008 as well as subsequent fieldwork. The judgements made within this report are based upon evidence found on the inspection visit along with feedback from service users and relatives provided via questionnaires, comments from which are included within the main text of this report. The Registered Manager of Butterfly’s was available throughout the inspection visit and contributed fully to the inspection process. The visit to Butterfly’s included an environmental tour of the home, discussions with people living at the home, staff and the home manager, as well as the opportunity to look at records of how people living at Butterfly’s were supported and how the staff were recruited and trained. What the service does well: What has improved since the last inspection? This was the home’s first unannounced inspection visit since it was registered in 2008. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 6 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. Butterfly`s DS0000071469.V370592.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 Butterfly`s DS0000071469.V370592.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 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with the necessary information to enable them to make an informed choice about the home’s ability to meet their needs. The home has a comprehensive needs assessment process, however these are not always fully completed before admission. People looking to move into the home can ‘test drive’ the home before deciding if it will be able to meet there needs. EVIDENCE: The home’s Statement of Purpose was viewed and found to provide service users with sufficient information to enable service use to decide about the home’s ability to meet their identified needs. The information provided included details of the registered provider and manager including their experience and qualifications, the number of staff employed including their experience and qualifications, the home’s process for admitting people into the home, details regarding the facilities on offer, including the number of rooms available and their sizes. Included in the Statement of Purpose was reference to the home’s complaints policy and procedure. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 9 The home had only been open for a few months at the time of the site visit, and both of the service users in residence had only been at the home for a few months, both had had pre-admission assessments undertaken, although examination of both care plans showed that not both assessments had been fully completed, discussion with the registered manager indicated that the assessment not yet fully completed was in the process of being updated. The pre-admission assessments undertaken covered the following area’s: promoting independence, medication, skin care, mobility, oral health care, allergies, hair and ear care. The care plan for the service user whose assessment had been completed was seen to be based upon this initial assessment of need. Both care plans were supplemented by Community Care Assessments (COM5s) These are assessments, which are undertaken by the placing authorities. Observation of interactions between service users and staff indicated that the home was able to demonstrate capacity to meet the assessed needs of the service users in residence. Butterfly`s DS0000071469.V370592.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs and personal goals are reflected well in their care plans and People were supported to take risks as part of an independent lifestyle. People living at the home were consulted on all aspects of life at the home. EVIDENCE: The individual plans of care and records examined as part of this inspection showed that those living at Butterfly’s contributed to their construction and to their ongoing review. The care plans reflected the individuality of the person and the uniqueness of each person’s needs. Individual’s likes and dislikes were recorded, and discussion with individual service users indicated that they had been consulted regarding these. Conversations with carers showed that there was an understanding of the issues within the individual plans of care and that these were followed and there were regular meaningful entries in daily records that showed needs were being met. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 11 Discussions with people at the home showed there was a process of active and responsive consultation at Butterfly’s in relation to the day-to-day running of the home. There were records of resident meetings regarding a range of subjects including activities, trips and menus and these discussions formed the basis for planning and developments at Butterfly’s. There were comprehensive risk assessments conducted for each person living at Butterfly’s along with clear risk management plans to ensure individuals were supported to take risks as part of developing an independent lifestyle. These included environmental risks for both inside and outside the home as well as risks that may have been encountered while undertaking planned activities. Butterfly`s DS0000071469.V370592.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Butterfly’s were able to take part in a wide range of activities tailored to their individual needs and preferences and were active members of their local community. Rights of individuals were respected and relationships were positive for those living at Butterfly’s. EVIDENCE: Individual care records sampled showed that each person living at Butterfly’s had a detailed weekly programme of activities both inside and outside of the home. These activities included, education and leisure type activities, including meals out, going to the cinema, swimming and attending a bingo club in nearby Colchester. One member of the care team takes the lead on activities, and has started to maintain a folder of local events. People spoken with on the day of inspection stated that they used community facilities as part of their daily lives and enjoyed the activities on offer. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 13 Discussion with people living and working at Butterflys, as well as the examination of records, showed that peoples rights were respected and appropriate personal relationships supported. The observation of interactions between those living at the home and care staff showed evidence of relationships that were built on mutual respect and trust (service users survey stated ‘I like all of the staff that support me, and I get on very well with the manager, and find them easy to talk to). Staff were seen to knock on doors before entering a persons private room and the way people talked to each other showed that dignity and respect was upheld. Visitors were welcome at the home at any time and people living at Butterflys were able to receive guests in private if they wished. During the course of the visit a member of staff was seen notifying a service user of a forthcoming visit that had just been arranged by a relative. Both of the relative surveys returned indicated that the home actively supported their relative to keep in contact. The examination of records and discussions with the home’s manager provided evidence of those living at Butterfly’s receiving a healthy diet. Menus were developed through discussions with service users and service users were encouraged to take part in meal preparation, (one service users record showed that they had assisted in cooking a Lasagne for tea the night before) and in shopping for foodstuffs. Butterfly`s DS0000071469.V370592.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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users received personal support in the way they preferred and required and physical and emotional health needs were met. People were protected by the home’s medication policies and procedures. EVIDENCE: Both of the service users living in the home were quite independent with regards to meeting their personal support needs and spoke of being happy with the way they were supported and this was reflected within their care plans. Care plans identified individual needs as well as the person’s preferences for how these needs could be met. Care plans were seen to be well detailed. Discussion with service users indicated that routines within the home were flexible, allowing them to choose when to retire to bed and get up in the morning. Mealtimes on the day of the visit were seen to be flexible, with Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 15 service users being provided with breakfast during the course of the morning as they awoke. Neither of the service users retained their own medications. Medication is dispensed via a combination of (MDS) Measured Dosage System and individually named containers. The home does not maintain any controlled medications. Medication is only administered by senior care staff, following completion of training provided by the dispensing chemist, supplemented by in-house assessments All medications were kept within a locked cabinet in the home’s office. All medication records examined were appropriately maintained, with no evidence of any gaps or omissions. Medication no longer in use was returned to the dispensing chemist via a pharmacy returns book. The home’s medication policies, procedures and practice provided protection to the people living at Butterfly’s. Butterfly`s DS0000071469.V370592.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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Butterfly’s could expect their views to be listened to and acted upon. There were robust arrangements in place to afford protection for those living at the home from abuse, neglect and self-harm. EVIDENCE: The home had a robust complaints procedure, which provided a definition of what constituted a complaint, the procedure provided guidance on how complaints should be dealt with from both service users and staff, the procedure included the timescales within which a complaint should be responded to. Discussion with service users indicated that they were aware of who they should address any concern or complaint to. The home does maintain a complaints log for the recording of any complaints or concerns raised. At the time of the site visit no complaints had been received by either the home or the Commission for Social Care Inspection. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 17 Discussions with people living at the home indicated that if a person had a concern it would be listened to and acted upon. People living at Butterfly’s were very positive about the approachability of the staff and management. Interactions observed were positive and appeared genuine. The adult protection policy and procedure were sampled and included a definition of abuse, and examples of the types of abuse that may occur, and how these may present. The procedure provided staff with clear guidance on the actions they should follow in the event of an allegation being made, with a comprehensive list of things they should and should not do. Discussion with the home’s registered manager conveyed that they had a good understanding of adult protection and also confirmed that all staff had received training in adult protection. Certificates relating to safe guarding were seen when viewing staff recruitment files. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 18 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, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Butterfly’s benefit from a homely, comfortable environment that is well maintained and clean. The home is equipped to meet the needs of the people living there. EVIDENCE: An environmental tour of the home showed that service users lived in a homely, comfortable and safe environment, which was well maintained both internally and externally. The premises were in keeping with the local community being situated in a residential area of Alresford. The home and it’s gardens were readily accessible to the service users, who were seen to have unrestricted access to both. Furnishings and fittings in the home were of a good quality and were domestic in nature. Each service user had their own bedroom which suited their individual needs and lifestyles and promoted independence. All rooms had en-suite toilet facilities. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 19 Laundry facilities were domestic in nature and were adequate to meet the needs of the service users in residence. Discussion with service users indicated that they assisted in taking their laundry through to the laundry room. On the day of the inspection the home was found to be clean and tidy and was free from any unpleasant odours. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 20 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): 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Carers at Butterfly’s were appropriately trained and skilled to meet the individual and group needs of those living at the home. Staff recruitment practices afforded support and protection to those living at Butterfly’s. EVIDENCE: Examination of staff recruitment and training records, as well as discussions with the Registered Manager and staff, provided evidence that care staff were qualified and competent, six members of the care team have a National Vocational Qualification (N.V.Q) at level 2 or above.. Records of four staffs recruitment files showed that all required pre-employment checks were undertaken including references, criminal records bureau check (CRB). These were collected prior to staff commencing employment to ensure the protection of those living at Butterfly’s. Staff were employed in sufficient numbers to meet the needs of the service users and were well trained with access to induction to Skills for Care standards. Staff spoken with on the day of inspection stated that training was Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 21 generally good regularly made available and the home’s Manager fully supported staff in meeting their training needs. Sampling of the records of the four staff indicated that they had received a reasonable level of the home’s training in: fire safety, manual handling, first aid, Pova (protection of vulnerable adults), health and safety in the workplace and basic food hygiene. Staff were observed as caring and professional in their approach and interactions with service users, interactions observed were polite and respectful and indicated a mutual rapport between both the service users and the staff. The examination of staff records showed that there was a process in place for formal support and supervision of care staff although discussion with staff indicated that they expected to be supervised every three monthly. This was insufficient to ensure that staff development needs were being fully met or that any concerns regarding carers’ performance would be identified or addressed. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 22 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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Butterfly’s benefited from competent management of the home and could feel confident that their views underpin developments. The health, safety and welfare of people living and working at Butterfly’s were promoted and protected. EVIDENCE: The registered manager had significant previous experience of working in the care sector, and at the time of the inspection was undertaking their National Vocational Qualification (N.V.Q) level 4 in Care Registered Manager Award. The registered manager was only responsible for the one establishment and was able to provide evidence of undertaking further training to enable them to Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 23 remain abreast of change in the field of Learning Disabilities. The registered manager spoke of being well supported by the home’s registered provider The home’ quality assurance process is taken from their sister home, and is based upon the use of questionnaires which are sent out to service users, relatives, community nurses and other interested stakeholders. To date given the newness of the service this process has not yet been implemented. Discussion with the registered manager indicated that it was their intention to hold service users meetings every three monthly and team meetings every three to six monthly, both of these would feed into the quality review process. Discussion took place with the registered manager regarding Regulation 26 visits, the manager was not really conversant with the visits, therefore there attention was drawn to the need for these visits to be undertaken by the registered provider on a monthly basis, and to ensure that reports from these visits must be made available to the home. The registered manager was able to see how these visits and the reports from them might support their quality assurance process. The home’s safe working practices were sampled through the viewing of the following safety certificates; electrical installation certificate, emergency lighting inspection report, fire fighting inspection certificate and gas installation certificate, all of which were current. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 3 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 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 2 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 3 X 2 X X 3 x Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 25 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. Standard YA2 Regulation 14(1a) Requirement Timescale for action 30/11/08 2. YA39 26(1) All service users admitted to the home must have their needs fully assessed and documented before admission to the home. This is to ensure that the home is able to meet their assessed needs and to enable the development of a plan of care. The registered provider must 30/11/08 undertake monthly Regulation 26 visits, and provide copies of reports from these visits to the home. This is to ensure that the home’s performance is kept under review by the registered provider, 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 YA36 Good Practice Recommendations It is recommended that the frequency of staff supervision be increased. This is to ensure staff development needs are being fully met or that any concerns regarding carers’ DS0000071469.V370592.R01.S.doc Version 5.2 Page 26 Butterfly`s performance could be identified and addressed. Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Butterfly`s DS0000071469.V370592.R01.S.doc Version 5.2 Page 28 - 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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