Care Home: The Chestnuts

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What the care home does well The service provides people with good flexible individualised care. People are able to make their own decisions and staff help is available when required. One person said "staff help me to do the things I want to do". Support plans show the care that the person needs and how this is to be given. The plan includes people`s preferences around very important small aspects of their lives, such as their getting up routine. Staff are trained and know their roles and the duties they are to perform. What has improved since the last inspection? Three requirements were set on the last inspection. The first could not be taken any further because planning permission was not granted for the extension. The second and third have been successfully completed. Staff have completed a training course in equality training. Additional fire training has been given and records show that monthly drills are carried out. Seven recommendations were suggested to the home. Some of these have been delayed a year due a local college not being able to provide training. Discussions with a local authority about finance for holidays were resolved but too late for a holiday to take place in 2007. The home plans to arrange a holiday in 2008. What the care home could do better: People would be further empowered by having ownership of their support plan, including risk assessment and show ownership by signing the documents. Support plans are individualised and it is planned to develop person centred planning which will provide an ideal opportunity for people to have their say. CARE HOME ADULTS 18-65 Chestnuts The 14 St Helens Road London SW16 4LB Lead Inspector Jean Stuart Key Unannounced Inspection 7th January 2008 1.30pm Chestnuts The DS0000025846.V341945.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 Chestnuts The DS0000025846.V341945.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. Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnuts The Address 14 St Helens Road London SW16 4LB 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) 020 8765 0299 NONE Mr Michael McDonagh Mrs Denise McDonagh Post Vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2006 Brief Description of the Service: Chestnuts is registered as a home offering support to five adults with learning disabilities and either Autism or Aspergers Syndrome. Chestnuts is a large detached house located in the heart of Norbury a few minutes walk from local shops, rail and bus services. Chestnuts has five single room situated on the second floor. The lounge is large and comfortable. The wood-panelled dining room is a good size, providing a valuable additional communal space for people. There is a large back garden, which the people who use the service make good use of. The fee range for the service is £850 and £1050. Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and completed over one day. The site visit lasted five and half hours. Five people, three members of staff, and the manager were spoken with. The view of one care manager was sought. Records relating to support plans, staff recruitment and medication were seen. A tour of the premises was undertaken. Information from the home’s Annual Quality Assurance Assessment has also been included in this report. Five people living in the home, and two staff returned survey forms. One individual said it is “good living here”, another person stated they “feel supported by staff”. All people were happy at Chestnuts no one complained about the care. Assessments and care plans are comprehensive and record good quality information about the support needed by each person and how this should be given. Risk assessments are up to date and protect the person from harm. The care manager reported that the “ manager takes control of what is going on about a person’s care”. The contribution of people to their care plan is difficult to establish. Individuals do not sign any of the documents to show ownership of it, nor do they have an advocate acting on their behalf. Individuals take part in activities and are part of the local community. Families are regular visitors to the home. Some people go out independently, and take responsibility for their own monies. Individuals take on responsibility for their own bedroom, other people Hoover and peel the vegetables, they do not contribute to the cooking. Meals are balanced and varied. The complaint procedure is accessible and has recently been used by one individual. The procedure has been used in a satisfactory manner. Staff receive good training and provide good support to individuals. The manager is competent and ensure people are kept safe. The environment is comfortable and homely ,clean and hygienic. Some areas require attention to ensure a good standard is maintained. The manager reported this is in hand. What the service does well: The service provides people with good flexible individualised care. People are able to make their own decisions and staff help is available when required. One person said “staff help me to do the things I want to do”. Support plans show the care that the person needs and how this is to be given. The plan includes people’s preferences around very important small aspects of their Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 6 lives, such as their getting up routine. Staff are trained and know their roles and the duties they are to perform. 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. Chestnuts The DS0000025846.V341945.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 Chestnuts The DS0000025846.V341945.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are fully assessed before living at the Chestnuts, and people are confident that needs can be met. EVIDENCE: There have been no recent admissions to the home. People are assessed before coming to live there. One person said “I visited Chestnuts prior to moving”. Three assessments were seen. The assessment format is individualised setting out peoples’ needs and preferences. The home is aiming to develop person centred planning (P.C.P.) for all individuals. One P.C.P. has been developed assessment demonstrated the person’s contribution in their own handwriting. It is advised that as far as possible all assessments are understood and signed by the person to show their ownership of the assessment. Chestnuts The DS0000025846.V341945.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 good. This judgement has been made using available evidence including a visit to this service. Comprehensive support plans are regularly monitored and reviewed by staff, and good care is delivered. Risk assessments are used to ensure people are safe. The service understands the rights of individuals to take control of their own lives but staff need to be able to understand how to put this into practice. Peoples care needs are identified and appropriate care given. EVIDENCE: Support plans are in place for each person who uses the service. Communication aids, photograps, symbols help peoples understanding of documents. A member of staff reported that “ care reviews are regularly done, and risk assemments updated”. These give information on individual needs, such as communication, personal care and activities. Encouraging choice, and Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 10 independence. The support plan is focused on the individual’s strengths and makes reference to equality and diversity, looking at matters such as age, race, and gender. When possible staff of the same sex as the person give care. This is always possible for females. As shown by paper work support plans are developed with the person. When two of the people were asked their input to the support plan they both reported that staff do the paperwork. The home has a key worker system and each month the key worker produces a summary of what has happened for the individual. The individual’s input to this system is difficult to see. Support plans are reviewed every six months. This level of information enables staff to meet the individual needs of people. People are encouraged to make decisions for themselves. Some people are independent and make regular use of shops, one person spoke of their “trips to the bank”. Two people decided to go for a walk early evening and staff accompanied them. Evidence of people making their own decisions was seen in practice and written guidance. The people who live there have meetings, which are well recorded. Reflecting the activities people would like to follow and any issues which people are not happy with. This gives people the chance to contribute to the running of the home. As noted on the site visits and in the AQAA, risk assessments are “to promote independence whilst ensuring safety”. A care Manager expressed some concern about the home’s ”failure to develop daily living skills” stating that some people are “over cared for”. During this visit it was noted that the staff were responsible for cooking the meal, other people carried out the preparation. Risk assessments are in regular use. Staff reported how “risk assessments make sure people are safe”. Chestnuts The DS0000025846.V341945.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): 12,13,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to make their own choices about their lifestyle. Using community facilities with friends and family. Enjoying the rights and responsibilities of every day life. People using the service are actively encouraged to develop independent living skills. EVIDENCE: People are free to use any part of the house at any time. Some people had chosen to have lunch the lounge another person chose to use the dining room. Later in the day when all people were at home, one person with staff help arranged mugs of tea for everyone. In the afternoon the dining room was used by an individual to write thank you cards for Christmas gifts, two other people helped to take down the Christmas tree, later in the day two people went out Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 12 for a walk. From talking with people and observing reactions to staff it could be seen that people are aware of the routines of the home and of what was happening that evening. The group was calm and comfortable. People enjoy a range of activities and outings. Including day centres outings to shops and cafes and to social clubs. A happy person returned home from the day centre and announced they had just been “ten pin bowling and got a strike”. One person reported they were waiting for the “good weather to get out in to the garden”, this person grows vegetables and flowers for the house. This individual has a separate shed for their use and has a key to “make sure it is safe”. People’s rights are respected and alongside this are responsibilities, which are part of every day life. Further support in developing people could be through the use of an advocate who could represent their interests. Holidays are planned around what individual people want to do. Some people have recently been to Bognor Regis, and “had a very good time” with staff for the weekend. It is hoped there will be a holiday abroad next. Visitors are encouraged and relationships are maintained with family and friends. One person reported that they often meet with the family and “goes home to stay with mum”. This was supported by the AQAA. People all eat in the dining room but it is not expected that they will all eat together. The preparation of the meal is shared. Some people “ set the table and peel the potatoes”, another person said they “always enjoy helping”. The this was said by people before the meal and was confirmed by activities on the day. The menu reflects people’s preferences and special diets. An individual record is kept for each person, and is available for the dietician when required. The meal served was hot and was enjoyed by all people, with assistance given by staff when require. Chestnuts The DS0000025846.V341945.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, 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive personal and health care support in a way they prefer. Staff ensure that care is person led and is flexible and meets their physical and emotional needs. Arrangements after death are discussed within the individual’s support plan. Arrangements for medication are well managed. People receive care that provides for their health care needs and staff listen to what is important to them. EVIDENCE: Key workers make sure that the team is aware of each individual support needs, and how they choose to receive support. Peoples support plan have good detail of how care is to be delivered. Staff work in a person centred way with care very focused on the individual. Information on personal needs and healthcare are detailed in support plans. Contact with specialist services , for example hospitals, the Community Learning Disability Team was apparent from paper work. One person spoke of regular trips to hospital for treatment “three Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 14 times a week by hospital transport” for a physical need (this is documented in the paperwork), another person had a planned appointment, a review with the psychiatrist. Family were to accompany the person. A care manager stated their concern that the physical and emotional needs of one person who has complex needs are not always attended to. The home is now working with people about their wishes on what support they would like in the event of a serious illness or death. Paper work confirming this was seen and mentioned in the AQAA. Medication profiles are in place and include a photograph of each person. No gaps were seen on the administration sheets for medication. A record is maintained of any medication leaving the building. The files reflect medication training and staff confirmed this. Training ensures medication is given safely and that the well being of service users is protected. One person stays away from home on a regular basis and how the medication should be recorded was discussed with two staff members. The manager is asked to make a statement to staff about the administration record and how a person’s absence from the home should be recorded. Chestnuts The DS0000025846.V341945.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. People feel able to state their views and complain if required. Staff know the importance of taking peoples view seriously. People feel safe and well supported. EVIDENCE: Individuals feel safe and well supported and are able to state their ongoing daily concerns to staff. As seen during this visit all staff know the importance of taking peoples view seriously and responding to the issues raised. There is a good complaint procedure. The home has received one complaint since the last inspection, this was from a person from the Chestnuts. This individual’s complaint is logged in the complaint record. The planned action to resolve the complaint has commenced but is yet to be completed. Two individuals reported that if they were not happy they would speak with the manager. The survey forms showed that people would speak with their key worker or the manager if they wished to complain. Training records show that staff have received training in the protection of vulnerable adults to minimise the risk to people. Staff confirmed this, when speaking about training. Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 16 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): 24,26,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The accommodation meets the needs of people. Redecoration and recarpeting of the home is planned and will improve the environment. EVIDENCE: The Chestnuts is a large house set over three floors. Communal areas are located on the ground floor. The place is clean. The manager reported that there is an issue with continence, however it is a credit to the home that there is no evidence of this. Three bedrooms were seen. People obviously enjoy their own space, bedrooms are personalised. People can have a key to their bedroom, this is supported by a risk assessment. Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 17 Some areas need redecoration and recarpeting. The manager reported work is planned to the first floor bathroom. Here tiles are cracked, other tiles are no longer adhered to the wall, an old damp patch has blistered the paintwork. Carpet that is old is to be replaced throughout the home. The areas identified above require attention, it was noted that the home and carpets are clean and smell fresh. Chestnuts The DS0000025846.V341945.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): 32,34,35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Competent and experienced staff team ensure that people who use the service are well supported. All recruitment checks are complete before a person starts work. Staff are appropriately trained to support people. EVIDENCE: During the visit staff showed a good knowledge and understanding of the people who lived there. Staff got on well with people and the atmosphere was light hearted and relaxed. Staff have the skills to communicate effectively with people. Individuals reported highly of staff and the work they do, stating, “they help me”. Staff were very positive about the service and on a survey form stated how “the staff team works together to achieve good outcomes” for individuals. As noted in the AQAA the person’s care is discussed at hand over. A member of staff stated, “Any change in the clients medication, or behaviour is reported at Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 19 handover”. Handover on the day was observed. A full picture of peoples needs is gained through staff meetings, and progress meetings. Staff confirmed regular meetings take place, records were seen of these. The organisation has a training and development plan and staff have access to training, including National Vocational Qualifications. Staff training is given on essential areas such as protection of vulnerable adults, moving and handling, food hygiene, and fire safety. This provides staff with the knowledge and expertise to provide a feeling of safety for both people at the home and other staff on duty. Two staff reported on survey forms that training is relevant to their roles, and helps the understand the diverse needs of people, “we are always given training regularly, and have refreshers to keep updated”. Staff reported they receive regular supervision .A record of supervision was seen. Full recruitment checks are carried out for new staff including reference checks and Criminal Record Bureau checks. Chestnuts The DS0000025846.V341945.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): 37, 39,42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager communicates a clear sense of direction. People living there are the primary focus of the work staff do. People’s views are shared with staff on a daily basis, and annually they are a part of the home’s audit of services. Practices in the home safeguard people from harm. EVIDENCE: The manager demonstrated a clear vision and a sense of direction, and a clear understanding of best practice. Three staff were confident and knowledgeable when speaking in about their role and peoples needs. Staff were very positive Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 21 about the support and guidance given to them. Comments included the manager is “very open to our opinions” and “very willing to listen”. The service is people focused, all individuals are encouraged to achieve their goals with staff support if required. The service has an understanding of equal opportunity issues but this is limited by the home’s wish to always ensure people are safe which can conflict with the development of the person. The organisation has systems for assuring quality within its services. The AQAA informs us that people involved with the service are canvassed once a year about their opinion on the service . This includes people living at the home, stakeholders and families. Records of the surveys returned were seen. Regular Health and safety checks are carried out to protect the welfare of people using the service. Staff have received fire safety training and comprehensive fire safety checks have been completed by the contractor. Staff spoke of fire drills reflected in the paperwork, and the need for safe bath temperatures. The safe bath temperatures was spoken about by a person who said “staff always make sure the water is not too hot”. Regular checks are carried out and a member of staff has designated responsibility for health and safety. The AQAA showed all policies and procedures People in the home on the day were happy with how the service is delivered. Chestnuts The DS0000025846.V341945.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 Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 23 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 2 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 2 X 2 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 2 3 3 3 X X X x x Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 15 (1) Requirement The home must ensure that the support plan is written with the person, and ensure their needs fully known to staff. Timescale for action 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA7 Good Practice Recommendations Staff should be encouraged to undertake Person Centred Planning for people; this will provide staff with a greater knowledge of individuals. Staff should enable people to take responsible risks, thus giving the opportunity for a person’s personal growth. All medication should be recorded in a consistent manner by staff ensuring the safety of people using the service. The home must ensure the property is well maintained, ensuring the environment is safe and comfortable. YA9 YA16 YA20 YA24 Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Chestnuts The DS0000025846.V341945.R01.S.doc Version 5.2 Page 26 Chestnuts The DS0000025846.V341945.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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!