Care Home: Dearnevale

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What the care home does well People said they could make choices in their life whilst staying at Dearnvale. For example people said they often went out into the community with or without support from staff, chose what they wanted to do during the day and whom they preferred to spend time with. People were supported in taking risks as part of their daily living to enable them to be as independent as possible. People made comments such as "staff support me to get on with my life" and "staff give me the level of help I need on that day". Daily routines within the home were flexible and individual, for each person who uses the service. Activities were arranged for each individual. People very positive about the level of care and support they received at Dearnvale and made comments such as; "Staff are good here" "Staff are really helpful" Relatives were very positive about the service. Some comments were; "The care residents receive is brilliant" "Excellent staff, excellent home" Health professionals said that staff liaise well with them to ensure people receive a good level of support and made other comments such as; "The care is very good" "The staff at Dearnvale provide a good level of care" The home was bright, clean and welcoming. It had homely touches in the shared communal rooms and people had personalised bedrooms. People said the home was always kept clean and they felt comfortable living there. People, staff and relatives said staffing levels were good. Relatives said that staff were very visible around the home when they visited. Staff interviewed said that they really enjoyed working at the home and got a lot of job satisfaction. We found that the staff were very enthusiastic to improve the service further and support people in the home so they could become as independent as possible. Staff and people said they found the manager supportive. Throughout the inspection, the impression was that the manager and staff were committed to supporting and enabling people to lead fulfilling lives. What has improved since the last inspection? There had been positive action on the requirements listed within the last inspection report. The two requirements relating to recruitment and adult safeguarding documentation have been acted upon and resolved. CARE HOME ADULTS 18-65 Dearnevale Elizabeth Street Grimethorpe Barnsley S72 7HZ Lead Inspector Michael O`Neil Key Unannounced Inspection 2nd June 2008 09:30 Dearnevale DS0000065489.V364166.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 Dearnevale DS0000065489.V364166.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. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dearnevale Address Elizabeth Street Grimethorpe Barnsley S72 7HZ 01226 719000 01226 780882 mphillips@exemplarhc.com None Dearne Valley Health Care Limited 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) Amanda Michelle Griffiths Care Home 40 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20), Physical disability (40) of places Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 2006 Brief Description of the Service: Dearnevale is a purpose built care home. It provides personal care and nursing care for people with physical disabilities and for people with complex needs and physical disabilities. There are 4 units, 2 at ground level and 2 on the first floor. Each unit accommodates 10 people. There are stairs and lift access to the upper floor. There is a therapy and activity room available and people can meet with visitors in a quiet room if they wish. Each unit has a spacious dining area and spacious lounge; there are facilities for people to make their own drinks and snacks. The corridors and doors are designed to accommodate wheelchairs and the garden is accessible to people with mobility difficulties. The bedrooms are purpose built; they are spacious and include en-suite facilities. There are security keypads to doors and the staircases for peoples’ safety. The home stands in its own grounds, with gardens and parking space. It is well located to access local shops and pubs and there is public transport close by. The home is situated in the Grimethorpe area of Barnsley; there is public transport to the town, college, and leisure facilities. The Service User Guide, the Statement of Purpose and the home’s last inspection report were displayed in the main entrance. The manager provided the Commission for Social Care Inspection with information about the homes fees and charges on 02/06/2008. Cost per care hour is £17.50 per hour. There are additional charges for toiletries, hairdressing, chiropody and telephone calls. Dearnevale DS0000065489.V364166.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 2 star. This means that the people who use this service experience good quality outcomes. This was an unannounced key inspection carried out by Mike O’ Neil, regulation inspector. This site visit took place between the hours of 9:30 am and 4.00pm. Amanda Griffiths is the manager and was present during the visit. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. We also sent out surveys prior to the inspection, 2 were received back from professionals, 5 from staff,8 from a people who use the service and 13 from relatives. Information from the surveys and AQAA is included in the main body of this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home, check the homes policies and procedures and talk to 6 staff, relatives and seven people who live at Dearnvale. We checked all key standards and the standards relating to the requirements outstanding from the homes last inspection in June 2006. The progress made has been reported on under the relevant standard in this report. We wish to thank the people living in the home,relatives and the staff for their time, friendliness and co-operation throughout the inspection process. What the service does well: People said they could make choices in their life whilst staying at Dearnvale. For example people said they often went out into the community with or without support from staff, chose what they wanted to do during the day and whom they preferred to spend time with. People were supported in taking risks as part of their daily living to enable them to be as independent as possible. People made comments such as “staff support me to get on with my life” and “staff give me the level of help I need on that day”. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 6 Daily routines within the home were flexible and individual, for each person who uses the service. Activities were arranged for each individual. People very positive about the level of care and support they received at Dearnvale and made comments such as; “Staff are good here” “Staff are really helpful” Relatives were very positive about the service. Some comments were; “The care residents receive is brilliant” “Excellent staff, excellent home” Health professionals said that staff liaise well with them to ensure people receive a good level of support and made other comments such as; “The care is very good” “The staff at Dearnvale provide a good level of care” The home was bright, clean and welcoming. It had homely touches in the shared communal rooms and people had personalised bedrooms. People said the home was always kept clean and they felt comfortable living there. People, staff and relatives said staffing levels were good. Relatives said that staff were very visible around the home when they visited. Staff interviewed said that they really enjoyed working at the home and got a lot of job satisfaction. We found that the staff were very enthusiastic to improve the service further and support people in the home so they could become as independent as possible. Staff and people said they found the manager supportive. Throughout the inspection, the impression was that the manager and staff were committed to supporting and enabling people to lead fulfilling lives. What has improved since the last inspection? Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 7 There had been positive action on the requirements listed within the last inspection report. The two requirements relating to recruitment and adult safeguarding documentation have been acted upon and resolved. 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. Comments Dearnevale DS0000065489.V364166.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 Dearnevale DS0000065489.V364166.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): Standard 2. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were individually assessed prior to admission to ensure their needs could and would be met. EVIDENCE: Care plans showed that people within the service had been assessed before moving into the home. Risk assessments and a detailed plan of care reflected any specialist interventions. The manager and staff liaised with professionals, the person and their families to find out about people’s needs. The manager visited the person and undertook an assessment, prior to admission. Dearnevale DS0000065489.V364166.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): Standards 6, 7 and 9. People who use the service experience good quality outcomes in this area. We have made this judgement 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: Three peoples plans of care were seen. These contained information on aspects of personal, social and health care needs. The plans contained some good profile information, including records of medical /mental health support and risk assessments for all aspects of people’s day-to-day lives and behaviours. People said they were aware of what was in the care plans and said they participated in regular reviews with staff and visiting health professionals. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 11 Some people were unaware of which member of staff was their key worker. Some staff were a little unsure of their role as a keyworkker but were keen to develop this role further. In one plan checked it had not been made clear as to whether the person had agreed to certain limitations around the frequency of their smoking. This plan had been recently rewritten so the agreement may have not been transferred into the persons new plan. People said they could make choices in their life whilst staying at Dearnvale. For example people said they often went out into the community with or without support from staff, chose what they wanted to do during the day and whom they preferred to spend time with. Staff were seen to be supporting people in day-to-day activities. Care plans identified levels of support people needed. The manager and staff said they were working hard to develop plans further, with people, to promote as much independence as they could. People were supported in taking risks as part of their daily living to enable them to be as independent as possible. People made comments such as “Staff support me to get on with my life” and “Staff give me the level of help I need on that day”. Risk assessments were in people’s care plans and had been regularly reviewed with staff, people, relatives and other professionals. Dearnevale DS0000065489.V364166.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): Standards 12,13,15,16 and 17. People who use the service experience good outcomes in this area. We have made this judgement 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 given the opportunity to exercise their right of choice regarding their daily lives. 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. Activities were arranged for each individual. Group activities were also available. The home employed two full time Life skills Coordinators; the coordinators worked with people to help them develop their independence and try to live a fulfilling life. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 13 People said they enjoyed going out and said they spoke regularly to the coordinators so that their preferences could be catered for. People said they visited shops, pubs and other amenities in the village. People said they had been assisted to attend the local leisure centre and were hoping to register at the local college night school. People said they had used the minibus, which is owned by the service, on a frequent basis. They had been to the coast and were provided with transport to visit family in nearby towns and cities. Other people said they enjoyed using the computer room and small cinema room which were located in the home. People were supported to maintain family links and had the opportunity to meet people and make friends. Some people said they were looking forward to going away this year and were currently trying to plan holiday with the staff. People were given the opportunity to exercise their right of choice regarding the provision of meals and were supported by staff to eat as healthily as possible. A cook was employed and a choice of menu was offered. Snacks were also available for people who wanted to independently cook their meal. People said; “We always get a good meal” “The food is very good, with a good variety”. Dearnevale DS0000065489.V364166.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): Standards 18,19 and 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 people had access to health care facilities and any relevant specialists that were necessary. Records showed that people were assisted and supported by staff to make decisions and choices about all daily living needs. 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. Risk assessments were in place to identify any risks and how they can be managed. These assessments involved people and other professionals. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 15 People very positive about the level of care and support they received at Dearnvale and made comments such as; “Staff are good here” “Staff are really helpful” Relatives were very positive about the service. Some comments were; “The care residents receive is brilliant” “Excellent staff ,excellent home” Health professionals said that staff liaise well with them to ensure people receive a good level of support and made other comments such as; “The care is very good” “The staff at Dearnvale provide a good level of care” Medication checked was securely stored. All medications administered had been signed for. The manager confirmed that only qualified nursing staff administered medication. Dearnevale DS0000065489.V364166.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): Standards 22 and 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: A complaints procedure was in place, this was in an appropriate format and was accessible to people. People said if they had any concerns they would feel very comfortable in speaking to the manager about them. People said they knew how to make a complaint and who too. Staff confirmed they were aware of protection polices and procedures, they were able to describe the action they would take on receiving any allegations. Records were seen of recent adult safeguarding training people had undertaken. This ensured people who use the service were safe and protected. Dearnevale DS0000065489.V364166.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): Standards 24 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment, monitored at this inspection, had been maintained to the required standard to provide a safe, well-maintained environment for people. EVIDENCE: The home was bright, clean and welcoming. It had homely touches in the shared communal rooms and people had personalised bedrooms. People said the home was always kept clean and they felt comfortable living there. The garden was accessible from the ground floor, it was well maintained and had a patio area with good quality garden furniture. The home was well maintained .A maintenance person regularly checked the building and arranged for and/or completed renewals and repairs. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 18 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): Standards 32,34 and 35. People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get good support from staff who are trained and competent. Recruitment policies are followed ensuring the safety and protection of people who live at the home. EVIDENCE: People, staff and relatives said staffing levels were good. Relatives said that staff were very visible around the home when they visited. The manager stated that agreed staffing levels were being maintained and the staff rota identified agreed staffing levels had been met. At the time of our visit 3 qualified nursing staff and 11 care staff were supporting people. Additional staff included the manager, an administrator, cooks ,maintenance staff and domestic /laundry staff. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 19 Twenty one people were resident in Dearnvale at the time of our visit. The two Life skills Coordinators were at a shopping centre with people from Dearnvale. Three staff files were checked. The files contained a range of information including two references and a declaration of health and identification. The staff had undertaken a criminal record bureau check (CRB), at the enhanced level. For the members of staff recently recruited it demonstrated that a Protection Of Vulnerable Adults check had been carried out before they commenced employment. This confirmed thorough recruitment practices were in place, which was sufficient to safeguard people. Staff interviewed said that they really enjoyed working at the home and got a lot of job satisfaction. We found that the staff were very enthusiastic to improve the service further and support people in the home so they could become as independent as possible. Staff were able to talk about the various training courses that they had attended. Development and training records were checked these records showed when staff had completed mandatory training and refresher training. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 20 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): Standards 37,39 and 42. People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall management of the home was good, with policies and procedures in place to protect and safeguard people who use the service. EVIDENCE: The manager, Amanda, has many years experience within the nursing and caring profession and had obtained the Registered Managers Award. She is committed to ensuring that people staying in the home were consistently well cared for, safe and happy. Staff and people said they found the manager supportive. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 21 Throughout the inspection, the impression was that the manager and staff were committed to supporting and enabling people to lead fulfilling lives. Comprehensive quality assurance systems were in place to monitor aspects of the quality of care and services within the home, for example care plans and medication procedures. The operations manager continued to carry out monitoring visits, and complete regulation 26 reports. These state what she found during her visit and who she spoke to, all were available at the home and had been forwarded to the CSCI. Staff meetings and meetings involving people at Dearnvale were held and minutes of these meetings were seen. The company had recently undertaken a satisfaction survey of the service. The results of this survey were seen and were very positive. These quality assurance systems will help to ensure that the service is operating in the best interest of the people who live there. Accident/incident records were being maintained and these were monitored at the head office. The fire risk assessment had been reviewed in April 2008. No issues requiring attention were highlighted in the review. Staff said they had received recent fire safety and other health and safety training .A sample of records showed that staff were receiving this statutory training. At the time of the visit fire exits were clear and hazardous products were safely stored in the home. This will promote the safety and welfare of the people. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 22 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 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 3 X X 3 X Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 23 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. 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. Refer to Standard YA6 YA7 Good Practice Recommendations The role of the key worker should be made clear to people and expanded to ensure that peoples care is as individualistic as possible. Limitations on peoples choice should be clearly documented in individual care plans. Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Dearnevale DS0000065489.V364166.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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