Inspection on 06/02/09 for Holmwood

People living in the service are able to make decision about their daily lives with assistance when they need it. People are able to make contact with family and friends and they are able to participate in community activities. People are able to maintain choice and control of their own lives. The home provides wholesome and appealing meals. Complaints are taken seriously and acted upon. People live in a safe and well-maintained home. The home is run in the best interests of the people living there. People`s financial interests are safeguarded.

What has improved since the last inspection?

At the end of the last inspection in August 2008 there were nine requirements and fourteen recommendations and the home received an O star, which means that people at the time experienced poor quality outcomes. Individual plans of care now provide more accurate and clear information so that staff know how people need to be supported. The home now complies with new regulations and has a controlled drugs cabinet. The homes procedures for dealing with medication have been improved which ensures that people living in the home are protected. There is a duty roster available recording who is working in the home. Improvements to pre employment checks mean that people living in the home are protected. Training has been put in place for people working in the home to ensure they have the skills they need to meet people`s needs. All staff working in the home receive supervision, which means their care practice, and training needs are being reviewed regularly. The registered provider ensures that the commission is notified of any events in the home such as illness and deaths. Pre admission assessments contain more detail so that the home can clearly determine if they are able to meet an individual`s needs or not. More information is recorded in assessments and care plans. The registered provider has a sample list of staff signatures so it is clear from the record who has administered medication. Improvements to medication practice mean that people are protected. The registered provider continues to seek social and recreational activities for the people who live in the home. Infection control has improved by the provision of liquid soap and paper towels. The registered provider has taken action to ensure that 50% of staff are trained to National Vocational Qualification at level two. Recruitment procedures have improved which ensures the safety of people living in the home. All staff have received moving and handling training. All new staff are required to complete the skills for care common induction training when they start work in the home.

What the care home could do better:

At the end of this inspection there is one requirement and one recommendation. To ensure that the registered provider is fit to discharge her responsibilities fully she must complete the appropriate qualification. The registered provider should seek a safeguarding course from an accredited provider. Both the requirement and the recommendation are repeated at this inspection however we recognised that Mrs Gallagher has made effects to address both areas.

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Holmwood 39 Chine Walk West Parley Ferndown Dorset BH22 8PR Lead Inspector Tracey Cockburn Unannounced Inspection 6th February 2009 09:30 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 Holmwood DS0000026820.V374152.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. Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood Address 39 Chine Walk West Parley Ferndown Dorset BH22 8PR 01202 593662 NO FAX 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) Mrs Margaret Anne Gallagher Manager post vacant Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2 double rooms Date of last inspection 5th August 2008 Brief Description of the Service: Holmwood Care Home is owned and managed by Mrs Gallagher, it is registered to accommodate a maximum of 13 older people in nine single and two double rooms. The home normally operates with all rooms occupied singly. Nine of the bedrooms, all with en-suite baths or showers, are situated on the ground floor; the remaining two rooms are located on the first floor. The communal lounges and dining room are on the ground floor. There is no passenger lift or stair lift so those people accommodated on the first floor need to be mobile enough to manage the stairs. The home usually accommodates the more independent person, although full time care is provided. The back garden has established shrubs, hedges and trees providing a sheltered environment. There is garden seating on the patio. The front garden has mature trees and shrubs; a gravelled car parking area is available for visitors and staff to use. The home is situated in a quiet road a short drive away from the centre of Ferndown, which has a good selection of shops and local amenities. The fees per week are: £375 - £495 For interested consumers the web link to the Office of Fair Trading which is concerned with value for money and fair terms of contracts is: www.oft.gov.uk Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection took place without any warning and the site visit was split over two days. The first day was a week day morning and the second day was a weekend morning. On both occasions there were two staff on duty and Mrs Gallagher was present. In preparation we looked at the annual quality assurance assessment as well as the improvement plan submitted by Mrs Gallagher. During the site visit we spoke to people living in the service as well as staff who work there. We toured the building, reviewed the recruitment records, training information and care information. Throughout the report we use the term ‘we’ to denote the views of the commission for social care inspection. What the service does well: What has improved since the last inspection? At the end of the last inspection in August 2008 there were nine requirements and fourteen recommendations and the home received an O star, which means that people at the time experienced poor quality outcomes. Individual plans of care now provide more accurate and clear information so that staff know how people need to be supported. The home now complies with new regulations and has a controlled drugs cabinet. The homes procedures for dealing with medication have been improved which ensures that people living in the home are protected. Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 6 There is a duty roster available recording who is working in the home. Improvements to pre employment checks mean that people living in the home are protected. Training has been put in place for people working in the home to ensure they have the skills they need to meet people’s needs. All staff working in the home receive supervision, which means their care practice, and training needs are being reviewed regularly. The registered provider ensures that the commission is notified of any events in the home such as illness and deaths. Pre admission assessments contain more detail so that the home can clearly determine if they are able to meet an individual’s needs or not. More information is recorded in assessments and care plans. The registered provider has a sample list of staff signatures so it is clear from the record who has administered medication. Improvements to medication practice mean that people are protected. The registered provider continues to seek social and recreational activities for the people who live in the home. Infection control has improved by the provision of liquid soap and paper towels. The registered provider has taken action to ensure that 50 of staff are trained to National Vocational Qualification at level two. Recruitment procedures have improved which ensures the safety of people living in the home. All staff have received moving and handling training. All new staff are required to complete the skills for care common induction training when they start work in the home. 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 Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 8 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 Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a system in place to assess people before they move into the home this ensures that the service can be clear it can meet the individual’s needs before a decision is made. EVIDENCE: At the last inspection the report said: “We looked at the pre-admission assessment form that had been completed in respect of another resident admitted to the home. We found that the home uses a form that lists the areas of need, as detailed in the National Minimum Standards. We recommend however, that more detail be recorded, as comments recorded on the person’s pre-admission assessment form, such as, ‘Suffers from a minor physical problems’ and ‘....uses one or more aids’, concerning their mobility, does not provide sufficient information to determine whether the home can meet needs.” Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 10 At this inspection we found that the pre admission assessment has been updated and improved Mrs Gallagher told us that she understands how important it is now to write more detail in the assessment. We looked at three peoples files. Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People have individual plans of care which detail their care needs so care staff understand how people need and prefer to be supported. People’s health care needs are addressed. Medication systems have improved which makes it safer for people living there. People tell us they are treated with respect. EVIDENCE: At the last key inspection the report stated: “We found however, that the template being used for care planning was in fact more of an assessment form providing a detailed, comprehensive checklist of needs, with a place to add comments.” At this inspection we found that there have been considerable steps taken by Mrs Gallagher to improve care plans and provide more detailed information needed to inform staff. The care plans focus on what the individual can do. We Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 12 spoke to several staff that told us that the care plans are much better and contain more detailed information on the people they support. We found that daily records may sometimes need to contain more information on what is meant comments such as ‘confused this morning’ need to more clearly reflect how the confusion was. Another care record stated that the person could not remember the day or where they were. Some of the care records were very specific in recording how confusion was expressed. Mrs Gallagher has been reinforcing with staff the importance of good record keeping and stated that she will continue to work on consistency. We found that care plans are signed and dated and reviewed monthly. We spoke to five people who live in the home they told us they were very happy with the care received. One person told us they knew what was in their care plan and that staff supported them during the day. During both visits we observed that people are able to get up at a time of their choosing. We also observed that staff would anticipate needs such as bringing a hot drink into the lounge after someone has sat down to read the paper. We spoke to Mrs Gallagher about her concerns regarding the health of one person living in the home and we looked at the care file and could see the information and action had been documented as well as meetings with health care professionals. At the last key inspection the report found: “We were shown where medication is stored in the home; this being three locked cabinet’s in the kitchen area. This is not an ideal location for medication storage and should the planned extension of the home proceed, better storage facilities should be considered. We also found that the home does not have the correct facility for storing controlled drugs in line with new Regulations.” The last report also stated: “We also recommend that a sample of staff signatures be maintained of those staff who administer medication, so that it can be determined from the record who has administered medication” At this inspection we found that there is now a metal free standing medication cabinet secured to the wall, there is also a controlled drugs cabinet properly fixed to a solid wall. There is a sample of staff signatures taped to the medication administration record. Medication training has been provided to all staff by a pharmacy that has also audited the medication stock and records. People who live in the home told us that they treated with respect by the staff and able to do the things they want to. Holmwood DS0000026820.V374152.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are improvements to the recording of information on social and recreational interests so that an individual’s lifestyle in the home will match their expectations. EVIDENCE: At the last inspection a requirement was made that residents be consulted about opportunities for involvement in meaningful daytime activities of their choice. We found that information had been recorded concerning a person’s life history, so that social and recreational needs of people could be met. Mrs Gallagher told us that she had spoken with the people about providing more activities. Concerning communal activities, the home currently holds a bingo session in the home one afternoon week and fortnightly ‘motivation to music’ sessions are arranged in the lounge. We spoke to people in the home who said they were happy with the activities provided but did not wish for any more .We saw that the home had a large selection of puzzles, books and games available. One person attends a day centre on weekdays. Another Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 14 person we spoke with told us that they enjoyed reading and doing crosswords, and that magazines were bought for them. The people told us that they were free to get up and go to bed when they chose and that the staff were very supportive. They also told us that there were no restrictions placed upon them. The people we spoke with told us that the standard of food provided was good and that there was a choice of meals each day. We saw the menus for the home and this reflected a varied and balanced diet. Holmwood DS0000026820.V374152.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People should be confident that their concerns and complaints will be listened to and acted upon. EVIDENCE: The home has a complaints procedure and the people we spoke with told us that they had confidence that their complaints would be listened to and responded to appropriately. There have been no complaints since the last inspection. The complaints procedure is detailed within the Service User Guide, which everyone has access to. Mrs Gallagher told us that she has been trying to find a place on a safeguarding training course and is still trying to source a place. We have repeated the recommendation. Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a safe and well-maintained home, which is clean, pleasant and hygienic. EVIDENCE: In the report of the last key inspection it states: “ The home does not have an adequate laundry area, this being a washing machine in an enclosed cupboard area. We discussed with Mrs Gallagher the lack of hand washing facilities and it was agreed that a small sink in a cupboard down the corridor from the laundry area would be set aside for exclusive use of staff doing the laundry. Mrs Gallagher told us that should the proposed extension go-ahead, new laundry facilities would be provided. On the day of our visit we found that the home was clean and free from unpleasant odours. The home was in reasonable decorative order and furniture and fittings in a reasonable state of repair. We saw that work was Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 17 being carried out at the front of the home to provide more parking and better access.” At this inspection the manager told us that the planning application has been approved for the extension. We found the home was clean and free from unpleasant odours. We found that there was liquid hand soap in all bathrooms and paper towels. The home was warm; it was a very cold snowy day when we inspected. The path leading to the front door had been cleared of snow and ice. The kitchen worktops have been updated. We saw that staff are provided with gloves and protective clothing in the interests of infection control. Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Improvements to training and recruitment mean that people living in the home are in safer hands and staff are learning the skills they need to meet people’s needs. EVIDENCE: At the last inspection the report stated: “We looked at the recruitment records for one member of staff who had been recruited to the staff team since the last key inspection. We found that a criminal records bureau check, CRB, had been obtained before the person started working in the home. We recommend however, that the home retain the copy of the CRB until a key inspection with the Commission has been carried out, in line with guidance set by the Criminal Records Bureau. In some other respects the requirements of Schedule 2 had not been complied with; namely, there was no proof of identification of the worker within the recruitment records, the applicant had not supplied a full employment history and there were no written references obtained in respect of this person.” At this inspection we looked at the recruitment records for one person we found that there was a full employment history, two written references and proof of identification as well as a Criminal Records Bureau disclosure. Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 19 The last report states: “We asked to see a copy of the duty roster. Mrs Gallagher told us that she did not have a duty roster, as the staff worked the same shift patterns each week. She told us that she could evidence who had worked particular shifts, as she had a record in respect of the home’s payroll. It is a requirement that the home maintains a duty roster and that an adequate record is kept of who has worked each particular shift.” At this inspection we found that there was a duty roster in place. The report of the last inspection states: “Concerning the level of staff trained to NVQ level 2 or above, we were informed through the AQAA that 25 of the staff had achieved this level of training.” At this inspection we found that all staff have enrolled on NVQ 2 training and were starting the week after the site visit. Staff told us they were looking forward to starting the training. Mrs Gallagher has made changes to recruitment so that any future staff that are employed will be clear from the start and is part of the contract that they undertake an appropriate qualification. We looked at the training records for several staff medication training, emergency first aid, adult protection, and moving and handling were all completed during august, September and October of 2008. Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The registered provider has worked hard to address the shortfalls in the service to make the home a safer place to live. EVIDENCE: We spoke to Mrs Gallagher about the need to complete the Registered Managers Award, which she started some time ago, the company she was using closed, and Mrs Gallagher had not done anything to complete the work. Mrs Gallagher had an appointment with an education provider to find out what she needed to do to complete the work and receive the award. The requirement is repeated. At the last inspection the report stated: “ Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 21 Mrs Gallagher acknowledged that the staff were not receiving formal supervision in line with the standards of older people, although the staff receive day-to-day supervision of their work as Mrs Gallagher works alongside the staff in supporting residents. It is required that staff receive formal supervision in accordance with the National Minimum Standards.” At the last inspection the registered provider said: “She told us that in the long-term, should the planned extension proceed, she would like to appoint a Registered Manager. She agreed that in the meantime she would seek outside assistance in setting up management systems to ensure that National Minimum Standards and the Regulations are complied with.” We found at this inspection that Mrs Gallagher has started to clearly record all supervision. Staff told us they feel supported and that Mrs Gallagher is always available to speak to. Mrs Gallagher has with support set up management systems in the home. She has also undertaken additional training herself such as Mental Capacity Act training. We found that since the last inspection the manager has updated the statement of purpose and service user guide, care plans are reviewed monthly and a new medication policy statement has been introduced. The registered provider also told us that she has started a root and branch review of all policies and procedures to ensure that they match the practice in the home. We also found out that the manager has changed the terms and conditions of the staff employed in the home confirming that staff must start their NVQ training within 6 months of employment and complete the common induction standards within 6 weeks of employment. We looked at the fire records a fire service company completed an inspection on 5/08/08 and a certificate of inspection was available. Fire doors, escape route and emergency lighting had all been checked at the appropriate intervals. All staff received six monthly fire training in November 2008. Holmwood DS0000026820.V374152.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 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 18 2 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 2 3 3 X 3 3 X 3 Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP31 Regulation 10 (2) Requirement Mrs Gallagher must complete the Registered Manager’s Award. Timescale for action 01/09/09 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 OP18 Good Practice Recommendations Mrs Gallagher should attend training in adult protection from an accredited provider. Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Holmwood DS0000026820.V374152.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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