Care Home: The Limes

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What the care home does well The Limes is a homely, well managed home, well maintained and safe. Prospective residents have their needs assessed prior to admission and the information is used as part of the care planning process, which helps to ensure people`s needs are met. Each person at The Limes has a detailed care plan which describes their health, personal and social care needs. Residents also have access to healthcare professionals and they are protected by the home`s medication policies and procedures. All of these factors help ensure that residents` health care needs are fully met. The Limes has a very good complaints procedure, all complaints are dealt with appropriately and residents are protected from harm as much as is possible. Care staff are well trained, competent and skilled.An effective formal quality assurance process is in place. What has improved since the last inspection? The Home is free now from unpleasant odours. People living at The Limes receive care appropriate to their needs and wishes and care records reflect that for everyone. Increased staffing levels, which are more consistent, have helped to further improve and increase the provision of activities, occupation and interaction. Residents are protected from harm by safe medicine administration practices. What the care home could do better: Care staff need to receive formal supervision on a regular basis, in accordance with the national minimum standards. The Limes needs to be visited each month, in accordance with regulation 26 and a written report should be prepared and submitted to the Commission. CARE HOMES FOR OLDER PEOPLE The Limes 16a Drayton Wood Road Hellesdon Norwich Norfolk NR6 5BY Lead Inspector Debby Allen Unannounced Inspection 27th June 2008 08:00 X10015.doc Version 1.40 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 The Limes DS0000027285.V367304.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 Older People. 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. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address 16a Drayton Wood Road Hellesdon Norwich Norfolk NR6 5BY 01603 427424 01603 429003 thelimesmanager@btinternet.com 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 Michael Christophi Mrs Christina Dawn Laffey Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (11) of places The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Eleven (11) Older People of either sex and forty-one (41) people of either sex with dementia may be accommodated. The total number not to exceed 41. Date of last inspection: 30/06/07 Brief Description of the Service: The Limes is a care home providing care for 41 older people with dementia, which includes the facility to accommodate 11 older people who do not have dementia. All accommodation, including a choice of lounges, is on the ground floor, and there are secure gardens, which are accessible to all residents. Car parking is provided at the front of the home. The fees currently range between £343 and £402 per week for a shared room and £358 to £417 for a single room. A third party ‘top up’ is also added to the price of all single rooms. Residents are expected to pay for hairdressing, toiletries, magazines, papers, confectionary, chiropody and transport to events or hospital on occasions. The Limes DS0000027285.V367304.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 3 stars. This means the people who use this service experience excellent quality outcomes. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This inspection was carried out over a period of eight hours and included a tour of the premises, inspection of staff and residents’ records and the home’s records relating to health and safety. Discussions also took place with the manager and some of the staff and residents. No CSCI questionnaires had been completed or returned by residents, relatives/carers or staff prior to the inspection, although the manager had completed the Annual Quality Assurance Assessment (AQAA) and a copy was submitted to the Commission accordingly. Two requirements have been made as a result of this inspection. What the service does well: The Limes is a homely, well managed home, well maintained and safe. Prospective residents have their needs assessed prior to admission and the information is used as part of the care planning process, which helps to ensure people’s needs are met. Each person at The Limes has a detailed care plan which describes their health, personal and social care needs. Residents also have access to healthcare professionals and they are protected by the home’s medication policies and procedures. All of these factors help ensure that residents’ health care needs are fully met. The Limes has a very good complaints procedure, all complaints are dealt with appropriately and residents are protected from harm as much as is possible. Care staff are well trained, competent and skilled. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 6 An effective formal quality assurance process is in place. 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. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 - Quality in this outcome area is excellent. Prospective residents have their needs assessed prior to admission and the information is used as part of the care planning process, which helps to ensure people’s needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose, Service User Guide and information pack were reviewed and fully updated earlier this year and the contents were seen to be clearly written, relevant and informative. The contents included information under headings such as: (1) Purpose & Objectives of The Home (2) Organisation & Staffing (3) Physical Environment of The Home (4) Facilities & Services Provided by The Home (5) Care Management (6) Quality & Improvement The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 9 Care plans for four residents were examined during this inspection and the information contained in them was found to be clear but comprehensive and provided evidence of a good pre-admission assessment. The admissions process continues to be that the manager or deputy will visit prospective residents either at home or in hospital and complete an initial assessment, which is used to help create a care plan. Information is also gathered from other people such as relatives, carers, social workers and hospital staff. The care plan for a person who had recently moved into the home contained clear evidence that the family had been to The Limes to look around, a full information pack was provided and a multi-disciplinary assessment was carried out, in addition to The Limes’ own pre-admission assessment. File copies also confirmed that Service User Guides (which include Terms & Conditions, Contract, Statement of Purpose, Complaints Procedure and confirmation of trial periods) are given to prospective residents prior to their admission. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is excellent. Each person at The Limes has a detailed care plan which describes their health, personal and social care needs. Residents also have access to healthcare professionals and they are protected by the home’s medication policies and procedures. All of these factors help ensure that residents’ health care needs are fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans were looked at in-depth, and a number of others were accessed randomly, during this inspection and improvements in this area were noted to have continued significantly. All the files seen contained a very well written information and guidance sheet regarding The Limes’ ‘Person Centred Approach to Care’ which read: N.B. In Confidence: A documented recollection of a person’s past is as detailed as the resident and their family wish. Insight into an individual’s past however can help those involved in their care to understand why they have current preferences, likes and dislikes. However, Keyworkers will always be aware The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 11 that the recollection of some events may be upsetting for their key-resident. A resident’s family may wish to discuss past events among each other before disclosure and they may also provide photographs and other information, which enhances a life history and contributes even further towards ‘Person Centred Care’. It was evident that the following of the above guidance by all parties has helped to improve the quality of individualised care planning and delivery. Each of the care plans looked at was made up of a number of sections such as: Person Centred Information Daily Notes Personal Details General Health Communication Washing (Hygiene & Appearance) Dietary Elimination Night Time Mobility Sexuality Each of the above sections was found to contain very detailed information and, additionally, contained a sub-section that clearly explained how to support each person, with dignity and respect, to maintain their independence and do as much for themselves as possible. An example of one of the entries in the ‘Hygiene & Appearance’ section is: [name] must be given a choice each morning and asked what she would like to wear and if she would like to wear any particular jewellery or perfume. Daily notes were seen to have been respectfully written and appeared to be factual and relevant and included good explanations of any situations or issues that may have arisen and any remedial action taken. The care records also contained information, which confirmed that residents also receive care as required from external healthcare professionals such as GP, district nurse, speech therapist, physiotherapist and dieticians. A copy of a letter from the Norfolk & Norwich University Hospital to the local GP was seen, commending the manager for initiating a recent referral and undertaking training of MUST (Malnutrition Universal Screening Tool). The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 12 The home has recently been divided up into three specific areas/corridors – Snowdrop, Lavender and Rose, to assist residents with recognising various locations in the home and enable more clarity and structure in respect of staffing, medication and care plans. This new structure has particularly helped to improve the way medication is stored, recorded and administered and each area has it’s own, lockable medication trolley, which is stored with individual records in one of the offices, which is kept locked. The maintenance of increased staffing levels has also helped improve the safety of medication administration and the medication and records looked at during the inspection showed everything to be in order, with no errors or omissions noted. Excellent information was seen to have been gathered in respect of people’s wishes regarding illness, dying and death. For example: [Name] wishes to be buried/cremated at… In addition to the above, personal information clearly written by the keyworker was also seen such as: If it is an expected death, [Name] should receive as much care as required. [Name] will need to be constantly reassured and not be left alone. The family will also need a lot of support and, if they wish to stay, they will be made comfortable, given meals and have privacy. When [Name] dies the procedure should be as in the Home’s policy book. If the death is unexpected, the emergency services should be called. At all times people are to be treated with professionalism and compassion. Discussions and observations helped to confirm that the above protocol is actually followed. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. Increased staffing levels have helped to further improve and increase the provision of activities, occupation and interaction. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Increased staffing levels appear to have remained consistent since the last inspection, which has helped to further improve the interaction between residents and staff and the provision of activities, which are available on a regular basis. Some of the recent activities noted included the following: Sunday services, Bingo, Reminiscence, Hairdressing & Manicures, Music & Sing-Along, Movie Afternoons, Cooking, Games Afternoons, Hand & Foot Massages, Touch & Feel Reminiscence, Memory Box Reminiscence, External Entertainers, Flower Arranging, Pub Nights and Individual Activities. One person in particular, was also noted to go out regularly with friends or family, frequently visit the local pub and have a daily paper delivered. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 14 The Limes also produce a monthly newsletter, which includes a prize puzzle section, and feedback from residents has shown that this is very popular with the majority. Observations during mealtimes (breakfast and lunch) showed people interacting with each other and being able to choose what they wanted to eat, where and with whom they wanted to sit. For example, some people were noted sitting with others at dining tables, some chose to have their meals on small tables in the lounge, while watching television, and others chose to have their meals in their own rooms. The residents observed appeared content, the atmosphere was very homely and the staff were seen and heard to be respectful, polite and cheerful. Staff were also observed offering meal choices for the day, although feedback following comments received within The Limes’ Quality Assurance Audit explained that meal choices in picture format had been tried but proved unsuccessful, therefore research into other possible aids is currently ongoing. Meanwhile, the meal choices were seen to be wholesome, varied and those seen during the inspection were nicely presented and appetising. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The Limes has a very good complaints procedure, all complaints are dealt with appropriately and residents are protected from harm as much as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure was seen to be very clearly presented and was noted to be available for people on the notice board by the main entrance, within the Statement of Purpose and as part of the Terms & Conditions/Service Users’ Guide. The results of The Limes’ last Quality Assurance Audit showed that thirty people had responded that the complaints procedure was clearly displayed, although one person did say that it wasn’t. From the records looked at during the inspection, all complaints are fully recorded and responded to appropriately and in accordance with the home’s complaints procedure. Other records looked at and discussions with staff confirmed that staff understood and had received training in areas of the protection of vulnerable adults, whistle blowing and recognising and reporting abuse or suspected abuse. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 16 Good record keeping was seen in the accident/incident book and regular audits were noted to have been carried out in respect of falls, with prompt and appropriate referrals being made the GP and physiotherapist. A clear guidance note for staff was also seen on the front of the accident book, which stated that assumptions of what had happened must not be included, only the facts, which also helps to protect residents from inappropriate actions or input following inaccurate conclusions being drawn. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is excellent. The people living at The Limes are able to benefit from a safe, well maintained environment, which includes well designed and maintained garden areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises showed the premises to be safe, well maintained, clean and hygienic, with no unpleasant odours noted during this visit. The home has recently been divided up into three specific areas/corridors – Snowdrop, Lavender and Rose, to assist residents with recognising various locations in the home and enable more clarity and structure in respect of staffing, medication and care plans. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 18 Meanwhile, the windows to the rear of the property have recently been lowered and made bigger, which has improved both the views and light into the bedrooms. All the bedrooms seen were light, airy, clean, spacious and nicely furnished and it was noted that residents are able to personalise their rooms and bring their own furniture, if they wish. People’s bedrooms were seen to have their names on the doors, plus a photo of themselves if they wanted, together with the name of the relevant keyworker. Adequate numbers of bathrooms, showers and toilets were seen, including an assisted bath, to enable the use of hoists if necessary. The gardens were seen to be very well designed and well maintained, with a number of different areas providing different views, colours and scents. There were a number of fairly secluded areas, providing an element of privacy and various bird tables and feeding stations were observed outside a number of bedroom windows. Good pathways, ramps and rails were also noted, making the gardens as accessible as possible for people who wanted to spend time outside. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 19 & 30 Quality in this outcome area is good. Since the last inspection, the increased staffing levels have become more consistent, as has person centred care, which means that residents are benefiting much more from the care provided by competent and skilled care staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rotas looked at, in addition to the staff seen on duty during the inspection, showed that increased staffing levels have become far more consistent in the last year. In addition to a minimum of two staff allocated to each of the three areas (Snowdrop, Rose and Lavender) throughout the whole week, there is a dedicated activities co-ordinator employed between 2 and 4 pm Monday to Friday. Other regular staff include regular laundry/domestic staff, kitchen staff, a part time maintenance person and a part time gardener. New staff receive induction training upon starting work at The Limes, with support from senior care staff and the deputy manager. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 20 The records looked at and discussions held with staff members confirmed that staff have received training in areas such as dementia care, protection of vulnerable adults, recognising and reporting abuse, fire safety, first aid, moving and handling, health and safety and person centred care. The home has a good complement of qualified nurses, together with a number of care staff who have completed or are undertaking NVQ level 2 plus the deputy manager and some senior staff are currently undertaking NVQ level 3. The personnel files were looked at for five staff members and all of these contained documentation such as application form, references, identification and clear, enhanced Criminal Records Bureau (CRB) disclosures, therefore confirming that the home/organisation has robust recruitment procedures, which helps to protect the service users. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is good. The Limes is a well managed home, well maintained and safe and a formal quality assurance process is in place. However, staff supervisions need to be carried out on a more regular basis and monthly visits need to be carried out and recorded by the provider in accordance with regulation 26. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was noted to be experienced and skilled and holds formal qualifications such as RGN, B.Sc (Hons) Nursing and a Diploma in Nursing. A formal quality assurance process was seen to be in place and copies of the results, feedback, summary and action plan were looked at during the inspection. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 22 Although the manager confirmed that the proprietor visits the home on a weekly basis there was no record of the monthly visits that need to be carried out and a report submitted to the Commission, in accordance with regulation 26. Records showed that support, supervision and appraisals are not being carried out with care staff on a regular basis. Detailed health and safety records and risk assessments were seen to be up to date and relevant, thus confirming the health and welfare of service users and staff are promoted and protected. The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 4 4 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 3 3 4 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 3 The Limes DS0000027285.V367304.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 OP36 Regulation 18 Requirement All care staff must receive formal supervision on a regular basis, in accordance with the national minimum standards. The Limes must be visited in accordance with regulation 26. A written report should also be prepared and submitted to the Commission on a monthly basis. Timescale for action 30/11/08 2. OP37 26 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 25 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 The Limes DS0000027285.V367304.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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