Inspection on 01/07/08 for Gleavewood

This is the latest available inspection report for this service, carried out on 1st July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gleavewood 14/10/05

Gleavewood 21/04/05

Gleavewood 22/09/04

Gleavewood 22/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Gleavewood Farm Road Weaverham Northwich Cheshire CW8 3NT Lead Inspector Maureen Brown Unannounced Inspection 1 July 2008 9:00 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 Gleavewood DS0000006504.V366655.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. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gleavewood Address Farm Road Weaverham Northwich Cheshire CW8 3NT 01606 853395 01606 852781 phil.caine@clsgroup.org.uk www.clsgroup.org.uk CLS Care Services 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) Manager post vacant Care Home 30 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (29) of places Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 29 residents to include: up to 29 service users in the category of OP 1 named service user in the category of LD 8 June 2006 Date of last inspection Brief Description of the Service: Gleavewood is a care home providing personal care and accommodation for up to twenty-nine older people. The home is owned by CLS Care Services, a not for profit organisation that runs a number of homes in the North West. It was purpose built in the 1980s and provides single bedroom accommodation on two floors. Gleavewood is situated in the village of Weaverham, approximately three miles from the town of Northwich. The home is part of the local community, close to shops, a library, surgery, two churches, a public house and the local bus stop. The bedrooms are all comfortable but eight are smaller than 10.00 square metres in size. Two bedrooms have an en-suite toilet. A passenger lift is available for access to the first floor. There is a range of communal areas including two lounge/dining areas, smoking lounge and a conservatory. There is a pleasant garden and patio area that is furnished with chairs, tables and sunshades for use in the warmer weather. The range of fees for this home is £450.00 to £465.00 per week. Additional charges are made for newspapers, hairdressing, toiletries and other personal expenses. Prospective residents are able to read the latest CSCI inspection report, which is available in a copy of the Service User Guide in the entrance hall. Other information about the home and CLS is available in leaflets on display in the hall. These outline the lifestyle that residents can expect when they move into the home. Gleavewood DS0000006504.V366655.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 stars. This means that the people who use this service experience good quality outcomes. An unannounced visit took place on 1 July 2008 and lasted seven hours. This visit was just one part of the inspection. Before the visit the home was also asked to complete a questionnaire to provide up to date information about its services. CSCI questionnaires were also made available for people living in the home and staff to find out their views. Other information since the last key inspection was also reviewed. During the visit various records and the premises were looked at. A number of people who live at the home, staff and a relative were also spoken with and they gave their views about the service. Twenty-four out of thirty-eight standards were assessed and all were met. All the key standards were assessed. The one recommendation made at the previous inspection had been met. Two recommendations were made following this visit. What the service does well: There is an established staff team at the home who were keen for high standards to be maintained so the people living there receive good quality care. Residents’ plans of care and individual case notes were well documented so staff know what they should do to meet people’s needs. Day to day supervision of staff was good and the staff receive formal supervision so they get support from the manager. Regular staff meetings were taking place so staff could have a say in how the home was being run. Meals were varied and reflected people’s preference. They offered choice and variety so people living at the home were able to enjoy a varied diet to help keep them well and healthy. The home is clean and well maintained so people live in a comfortable and homely surrounding. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 6 People living in the home told us: “The home is always fresh and clean and I always like the meals”; “The staff are available when I need them”; and “Staff are pleasant to me.” Relatives told us “Gleavewood is a happy atmosphere” and “we find the staff pleasant and helpful.” Staff said: “I am given training relevant to my role and I have also been offered NVQ training. The manager is approachable and helpful. There is always the correct number of staff on each shift although sometimes there could be more as the needs of the residents are increasingly growing”; “We provide a comfortable, clean and friendly environment putting the needs of the residents as a priority; “I was given an excellent induction. The home has an excellent team spirit and the staff are dedicated, reliable and well trained. The home is clean and tidy and provides good food”; and “It also provides an excellent service to all residents and their families. I am very happy working here and I feel I have been given the opportunity to get NVQ training and I can talk to the manager with any problems I may have.” 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. Gleavewood DS0000006504.V366655.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 Gleavewood DS0000006504.V366655.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, 3 & 6 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Sufficient information is provided to make sure that people can make an informed decision about moving into the home and know their needs can be met there. EVIDENCE: A copy of the statement of purpose and service user guide was available in each person’s bedroom. The service users’ guide was written in plain English and large print. A current copy of the last inspection report was also available. The service users’ guide included information about the home, aims and objectives, residents’ charter, services, all areas of care, the complaints procedure, staff details and a copy of the customer satisfaction survey analysis produced in 2007. The statement of purpose and service users guide had been reviewed in March 2008. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 9 Some of the people who live in the home confirmed that they were involved in planning their own care. Staff were aware of the needs of the people living in the home. Within each of their files there was an assessment that had been done before they moved in and which detailed their needs. Information gathered included personal details, details of next of kin, GP details, family involvement, social interests, communication needs and personal and healthcare needs. The assessor and person being assessed signed this. The manager confirmed that intermediate care was not provided at Gleavewood. Gleavewood DS0000006504.V366655.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 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The residents’ health, personal and social care needs are met by the staff team who enable them to maintain their privacy and dignity. Residents and relatives were satisfied with the support they received from the manager and staff. EVIDENCE: Three care files were checked during our visit. These files contained all the information necessary to ensure that people’s needs are met. The care plans were clearly written and covered all personal care areas including medication, eating and drinking, washing and dressing, work and leisure, and sleeping. There was also a life profile document, which showed details about a person’s past, and what is important to them. This was a very good document; it was completed with the resident, their family and key worker so it gave a good background on a person and their particular likes and dislikes. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 11 The daily records were kept in a separate file and these were well written with staff noting changes to people; activities undertaken and the details of visitors were also recorded. All files checked contained up to date reviews. Many of the people living in the home were not able to confirm that they had been involved in the care planning or review process. However they were able to confirm that staff helped them when they needed it, such as with personal care tasks and that staff were very good to them. A monitored dosage system for medicines is used in the home and these are stored in a steel drugs trolley. Unused medicines are returned to the pharmacist each month. Medication administration record sheets were seen and appropriately completed. There is a policy on the safe and secure handling and administration of medications and one on homely policies available in the home. A copy of the homely remedies sheets signed by the resident’s doctor was seen on each person’s file. The manager confirmed that staff had received medication awareness training and this was noted on their files. We saw medicines being given to people who live at the home during lunchtime and this was done correctly. The staff member went to each person and checked they had taken the medicine before moving on to the next person. Visits from healthcare professionals were recorded and it was noted that the GPs, district nurses, optician, audiologist and the chiropodist regularly visited people living in the home. Staff were observed interacting with residents during lunch. The staff were attentive to people’s needs and helped them when required. The general atmosphere within the home was warm and friendly. The aims and objectives for the home state that “the respect of residents privacy and dignity is an essential requirement of all our staff and we aim to recruit “natural” carers.” During this visit we saw that staff worked in a way that respected the privacy and dignity of the people living in the home. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 12 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 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who live in the home are able to take part in a range of activities. Personal and family relationships are encouraged by the home and the staff team help people so they can keep in touch with their family and friends. EVIDENCE: There is an individual life history sheet and activities undertaken sheet kept in each person’s file. People also have an activities profile that covers all their preferred activities. The home’s activity organiser uses these to help plan activities that people will enjoy. Activities on offer included nostalgia time, reading, keep fit, ball and bean bag throwing, beauty therapy, hairdressing, crosswords, bingo, arts and crafts, tea dances, listening to someone reading the paper, playing cards and dominoes. Church services are provided within the home and residents can attend as they wish. Other activities include “pat a dog”, a visit by the local mayor, visits to the local pub for lunch, garden centres, canal trips and visits to shows. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 13 The residents’ charter for the home states, “residents are able to receive visitors at any reasonable time”. Relatives confirmed that they were made welcome at all times of the day by the staff. The visits from families and friends were recorded in the daily record sheets, which were seen during the visit. People who live at the home were offered choices in various ways such as: choosing the time they get up in the morning and retire to bed at night; choosing the clothes they wear; deciding whether or not to join in planned activities. Also people can have a TV or telephone in their own bedrooms and the “life profile” document asks what the person’s preferred name is. There is a computer available in the dining room for people living in the home to use. Staff help them do this if needed. Some people living in the home have family in Australia and America and are able to keep in touch with them via e-mail. The menus were seen and the summer menu is currently being used. This is a four-week menu plan. It is mainly a traditional menu with some “new recipes” included to add more variety. The lunch was seen served; the main meal was sausages in onion gravy with mashed potato, fresh broccoli and peas followed by fresh fruit salad and ice cream. Alternatives were offered if people didn’t like the main meal and a choice of deserts were also available. After the meal people who lived in the home confirmed they had enjoyed it. They said “Very nice food” and “I usually like the meals.” Breakfast is served up to 10.00 am and a range of cereals, orange juice, grapefruit, cooked breakfast and toast and preserves were available. The main meal is at lunchtime 12.30 pm and evening meal is at 4.30 pm. The evening meal is usually a choice of soup, a hot light meal, sandwiches, salad, cake or a dessert. Drinks are available in between meals and supper is served at bedtime. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 14 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 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who use the service and relatives were satisfied with the support they received from the manager and staff. Clear policies are in place to ensure that residents were protected from abuse, neglect and self-harm. EVIDENCE: The staff files showed that they had received training on safeguarding adults, and the manager confirmed this. The manager knew the safeguarding adults policy and “No Secrets” document and copies of these were available for all staff. The home also had policies physical restraint, management of violent incidents and physical intervention by staff, recognising and reporting abuse of vulnerable adults and whistle blowing. One issue had been reported under the local authority’s safeguarding adults procedures since the last visit and this was recorded appropriately. The complaints procedure was seen and this contained details of how to contact the Commission for Social Care Inspection. Neither the home nor the commission had received any complaints since our previous visit. Service users spoken with confirmed they would contact the manager if they had any problems. The home also has a compliments file, which contained a range of cards and letters showing the appreciation of people who use the service and families for the kindness and support shown to them by staff at the home. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 15 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 & 26 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is well maintained so it provides a clean and comfortable environment for people to live in. EVIDENCE: A tour of the premises was undertaken. All the communal areas were seen and a selection of bedrooms. The home was clean and odour free. Rooms had been personalised by people living in them with items of their own furniture, pictures and mementoes. The home is in a good state of repair and that the décor is good. During the last year the decoration and maintenance programme has continued. This has included redecoration of the corridors and lounge, new chairs in two lounges, new carpets in the dining room and all corridors and new blinds and curtains in the conservatory and dining room. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 16 People living in the home told us that they liked their bedrooms and said, “The home is always fresh and clean.” The home was light, airy and was warm – people living in the home told us that it was warm enough for them. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 17 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, 29 & 30 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The recruitment procedures are thorough so people living in the home can be sure that the staff are suitable to work with them. Staff are well trained so they can provide good support for the people living in the home. EVIDENCE: The staff rotas showed the numbers of staff on duty over the week. This appeared to be enough to meet the needs of the people living in the home. In the questionnaires we sent out before our visit, staff had been asked to comment on improvements that could be made to the service. Their comments included, “to provide more staff to be able to do more individual things with residents” and “sometimes there could be more staff as the needs of the residents are increasingly growing.” However, residents told us there were enough staff to help them and we saw during our visit that staff were attentive to people’s needs. We checked three staff files. These had all pre-employment checks in place that included two references, Criminal Record Bureau checks, employment contracts and health questionnaires. People who live in the home take part in recruiting staff for the home by being included on the panel when new staff are interviewed. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 18 Mandatory training for staff includes fire safety, infection control, moving and handling, safeguarding adults from abuse, first aid and food hygiene. All staff have received this training. All staff had also received induction training. Specialist training includes MRSA, pressure damage, continence promotion, medication awareness training. Good progress has been made with NVQ training. Thirteen out of nineteen staff had NVQ level 2 in care or above, with five staff working towards it and one person waiting to go on the course. It was also noted that many of the staff also had NVQ level 3 in care as well. Care team leader meetings are held every three months with records kept. Areas covered include resident’s issues, medication, care issues, staffing, meals and staff supervision. Staff meetings are held every three months with records kept. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 19 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 & 38 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is managed in such a way as to make sure that the health, safety and welfare of the people who live there are protected and that the home is run in their best interests. EVIDENCE: The manager provides clear leadership for the staff team and is supported by care team leaders, care staff, cooks, an activities organiser, domestic assistants and maintenance support. She has NVQ level 4 and the registered managers award. She is also an NVQ assessor and verifier. She has worked for CLS for twenty years, eight of those in a managerial role. She has been the manager of Gleavewood for a year and is currently applying to be registered with the commission as the manager of that home. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 20 Quality assurance is carried out at the home. The latest survey was sent to people living in the home and their families in October 2007. Replies included the following comments: “I feel safe in the home”; “I don’t have to fit into a routine set by staff”; “private space is respected” and “mealtimes are relaxed and social occasions”. Other comments included: “I am treated in a way I feel comfortable”; and “I am treated well.” Relatives commented: “Gleavewood is a happy atmosphere”; “we find the staff pleasant and helpful”; and “some of the trips out are a little expensive.” A copy of the analysis from the replies is included in the service user’s guide. A manager from the organisation that runs the home visits monthly to check on how things are and copies of the reports are available for the commission to view. Residents’ meetings are held regularly, usually every eight weeks. The last one was in June 2008. Areas discussed included activities, meals and general issues. Minutes are made and copies of these are displayed on the notice board in the hallway. The manager confirmed that she keeps some money on behalf of the people who use the service. Appropriate records were in place; a sample of residents’ monies was checked and found to be correct. Money is stored securely in individual wallets. Safe working practices were in place. Fire safety checks on extinguishers and the fire system alarm system were up to date. Checks on the electrical wiring safety, hoist, heating and hot water system, nurse call and lift were all up to date. The home had policies relating to safe working practices including a range of risk assessments, COSHH, moving and handling and first aid. The accident file was seen and appropriate records had been made. Day to day supervision of staff was good with formal supervision and direct observations also being undertaken. However, records of when formal supervision and appraisals, some of which were out of date, should be made to show they happen regularly. Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 3 X 3 Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 22 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. 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 Refer to Standard OP36 Good Practice Recommendations Records should be made of formal supervision sessions with staff to show that these happen regularly so that staff are well supported in their work. Annual appraisals of staff should be take place regularly and be recorded to show that staff are well supported in their work. 2 OP36 Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@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 Gleavewood DS0000006504.V366655.R01.S.doc Version 5.2 Page 24 - 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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