Inspection on 25/11/05 for 10 Tanners Walk

This inspection was carried out on 25th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

10 Tanners Walk 08/05/06

10 Tanners Walk 29/06/05

10 Tanners Walk 27/01/05

10 Tanners Walk 10/06/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 10 Tanners Walk Off Newton Rd Twerton Bath Bath & N E Somerset BA2 1RG Lead Inspector Chris Lewis Unannounced Inspection 25th November 2005 10:00 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 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 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 10 Tanners Walk Address Off Newton Rd Twerton Bath Bath & N E Somerset BA2 1RG 01225 331192 01225 331192 robin.carr@new-era.org.uk 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) New Era Housing Association Limited Mr Robin Carr Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 5 persons aged 18 years and over with physical and learning disabilities for respite care. 29th June 2005 Date of last inspection Brief Description of the Service: Tanners Walk is a care home that provides respite care for up to five people who have a learning difficulty and physical disability. It is operated by New Era which is a voluntary organisation and is set within a purpose built, split level building located in Twerton, two miles from the centre of Bath. Accommodation is modern and the Home is fully accessible to those using wheelchairs. The Home consists of two floors, an upper entrance level and a lower ground floor. The upper floor has three single bedrooms, with a further two bedrooms in the lower ground floor. There is a communal lounge area, a kitchen/dining room and a laundry area on the upper floor and a communal lounge/activity room with a small kitchen on the lower ground floor. Parking is available to the front of the Home. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over six hours in total by Christopher Lewis, Locum Regulatory Inspector. The inspection was in two parts, with the earlier part of the day spent speaking with staff and examining records. Later the Inspector returned to talk with service users upon their return to the Home from their various daily activities. He was also at this later time able to observe the interaction between staff and people who use the service. The Inspector also spoke on the telephone some days later with the Manager (who was not on duty on the day of the inspection) to clarify various issues raised during the visit. What the service does well: What has improved since the last inspection? Tanners Walk’s service users guide is being reviewed and updated. Information collected on service users is now largely together in a more accessible form. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 6 The Home has made efforts to give the accommodation a more homely feel by providing more pictures and ornaments. The training on drawing up insulin is not now a necessity. Plugs in sinks are now provided if staff assess that there is no risk of flooding being present by their use. Showers that were seen to present a possible danger to service users are being replaced. Makaton training has now been provided for some staff. 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. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Service users are now being provided with an updated copy of the service users guide. A comprehensive referral and admission procedure is in place. Opportunities are given for people to visit and to try out the service. EVIDENCE: The Manager of Tanners Walk was not on duty at the time of the inspection, but an experienced support worker and later on the Area Manager were well able to help provide evidence of the way the service is run. Approximately 28 adults with a range of learning and physical disabilities are provided with respite care at the Home. The Area Manager confirmed that users of the service are now being provided with an updated copy of the service users guide (the lack of which was an issue at the last inspection). Full assessments of the needs of those using the service have been undertaken. All the places at Tanners Walk are contracted out to Bath and North East Somerset Council with the Community Learning Disabilities Team making referrals to the Home. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 9 The Home runs its own booking system that takes account of the individual needs of those who will be using the service and also the requirements of parents and carers. The service is operated in a flexible way in recognition of the way that the needs of its service users and their carers may change over time. A detailed referral system is used and completed referral forms were seen which proved that all relevant information is collected at this referral stage which will then help determine how best an individual user of the service might best be cared for. The Home’s senior staff have regular meetings with Social Services professionals and possible new referrals are always on the agendas of these meetings. The Home offers introductory visits to those who may wish to use the service coupled with trial overnight stays; if everyone concerned is happy, then respite goes ahead. Emergency admissions can be catered for, though it was emphasised that these are not encouraged. Such admissions usually happen because of such situations as the sudden illness of a carer. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 Care plans are in place, the majority in an accessible manner. Individual choices are encouraged as far as possible. Information about service users is kept safe and confidential. EVIDENCE: All service users have individual care files. Five were examined and were found to include such information as personal profiles, copies of assessments and material collected from various professionals who may have worked with the person. Information from previous placements is also included in some cases. The great majority of care files are now put together in a clearly written form which the Home calls support guidelines or person support plans; these guide staff on the actions they need to take to meet individual service user’s needs. The Manager gave assurances that these few files remaining in the old, less accessible format would be updated very shortly. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 11 Service users are encouraged to make their own individual choices while staying in the Home as far as possible and they are also supported, where they are able, to manage their own money. Some users of the service make their own way to the day care facilities they would normally take part in by bus. Service users on their return from their day care were seen to be encouraged to choose what they wished to do that evening and the staff described how recently people staying in the Home had chosen between staying in and watching a DVD or going to the cinema. Risk assessments were seen to be in place to cover aspects of daily life and as part of the general support of service users’ independence. Service users’ records are well looked after, being securely kept in filing cabinets in the main office. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Staff at Tanners Walk work hard to enable service users to enjoy their leisure time. Service users continue to attend their normal day care services and stays are well structured around these services. Food provided is adequate and healthy and service users have an input into the choice of menus. EVIDENCE: It was evident from records, discussions with staff and from the observations of the interactions between staff and people using the service that these service users are given opportunities and encouragement to develop personally during their stays in the Home. Service users were seen to be accessing all areas of the Home with confidence and to be treated with respect and care by all staff. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 13 Most of the people who have regular respite stays have day care services organised that continue while they are in the Home. During the latter part of the inspection, people were spoken with on their return from such day care facilities and, after being greeted warmly by staff, two service users were particularly keen to describe the day’s events to the Inspector. Both staff and service users also described organised trips out to such events as skittles, carnivals, the cinema and picnics at such places as Chew Valley Lake. Two service users said how much they enjoyed their stays at Tanners Walk saying, “It’s all right for me – it’s very comfortable” and “They look after you”. The Home’s communal lounge is equipped with a large television, a DVD player and a stereo system. Some bedrooms contain smaller TV sets. The activities room has various pastimes available, including candle-making kits, painting materials and musical instruments. Examples of paintings done by service users were on display. Staff explained that they plan activities as much as possible around whatever particular mix of people they have using the service at any one time. The individual service user’s files showed that the Home has a good liaison with family members with regular communications with parents and carers taking place. The Home’s routines are flexible within the parameters of the day care services accessed. Service users spoken with confirmed that they could largely choose at what time they got up and went to bed. A staff member prepared and served the evening meal during the inspection. The food smelt very appetising and people spoken with said they enjoyed the food. Service users are given a choice of what they would like to eat. Everything at this mealtime was relaxed and unhurried and the interaction between staff and people using the service was friendly and respectful. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 Staff support service users in a caring way and their health and personal care needs are met. EVIDENCE: Staff were observed to be interacting with the people who use the service in a helpful, calm and sensitive way. It was evident from conversations with staff and the Area Manager that all are committed to providing a good standard of care and that they are keen to promote the independence of service users as far as possible. The selection of five care files examined gave evidence that the support of Health and Social Services professionals is sought if a need is identified. People who use Tanners Walk respite service retain their own General Practitioner; GPs are requested to visit the Home if needs be though in most situations, a person’s relative or carer would be asked to take that person to the GPs surgery if this was necessary during their stay. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 15 Medication records were not looked at in any great detail having been found to be satisfactory in the past. People continue to self-administer their own medication it they are so able. The lack of evidence of staff having sufficient training in the drawing up of an individual’s insulin, which was noted in the past, is not now a problem as that person no longer uses the service. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Information for service users about making complaints is clear. Policies and procedures for the protection of vulnerable adults are also well established. EVIDENCE: New Era has a clear complaints procedure that includes a flowchart and sets out timescales for complaints to be dealt with. The home also has a pictorial document which is given out to service users which contains such matters as: “What is a complaint?”, “How do I make a complaint?” and “What happens when I do complain?” This document also gives information on contacting Social Services, the Commission for Social Care Inspection or the Police if service users wished to do so. No complaints have been made since the last inspection and users of the service spoken with said they were happy with the service they received. Staff also expressed general satisfaction both with their employers and the care offered to users of the service. Policies and procedures for the protection of vulnerable adults are established and conversations with staff confirmed that they had been trained on POVA issues. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 29 and 30. The Home is bright and clean with efforts having been made recently to give it a more homely feel. Service users like their accommodation and their privacy is maintained. New shower fittings have been purchased and should ensure the safety of people using such facilities once fitted. EVIDENCE: The Home is cheerfully decorated and generally well maintained. Furniture and fittings are good. All rooms are clean and tidy including the bathrooms and toilets that are free of any odours. Window restrictors are fitted to ensure safety. A new notice board has been set up in the kitchen/dining area that features pictures of the staff on duty and those people staying in the Home at any particular time, which is a homely touch. One service user enjoyed looking for his photograph and placing it on the board with the Inspector that proved how service users feel a sense of ownership about the Home. The upper level of the Home contains three single bedrooms one of which is en-suite with an overhead track hoist and fully assisted bath. The other two 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 18 bedrooms have washbasins. There are two other single bedrooms on the ground floor, also equipped with washbasins. The lack of plugs in sinks was commented on at the last inspection – some are now fitted; others are supplied at the discretion of staff often on assessment as to whether a service user is likely to flood the room. All the bedrooms were seen, two with the service users showing the Inspector around. Those spoken with about their rooms said they were happy with and comfortable in their accommodation. Comments were made in the past about shower fittings being of possible danger to service users as the temperature could not be properly regulated. New showers have been purchased and await the arrival of builders who have agreed to fit them. Subsidence, which was a major issue some years ago, is again a problem. It is particularly affecting the kitchen area and large cracks were evident in the walls, tiles and ceiling. It apparently poses no immediate danger and actions to rectify the situation are in hand. There are also plans for a major refurbishment of the kitchen where work surfaces and some units are showing signs of wear as mentioned at the last inspection. This refurbishment will need to go hand-in-hand with any building work. The Home has an activity room that the Area Manager said was at present underused. Consequently plans have been made to turn it into more of a general relaxation area and the kitchenette attached is to be used more. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36, Staff roles and responsibilities appear to be clear. Staff are trained to most aspects of their duties and are supervised effectively; however fire safety and manual handling training needs to be done. EVIDENCE: It was noted from observation, discussions with staff and managers and from a review of the Home’s records that clear lines of accountability exist within the Home. Staff also hold clear job descriptions. Excellent interaction between staff and service users was seen to be taking place with staff exhibiting, the necessary skills to respond with sensitivity to people’s needs as individuals. Staffing levels were appropriate to meet the needs of the people served with twelve staff making up the Tanners Walk team in total. The staff team consists of the Manager and Deputy, four full-time and six part-time support workers. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 20 Staff training was seen largely to be satisfactory at the last inspection. However, fire safety training was discovered to be lacking at that inspection; this training has now been started, but not yet completed for all staff. The Manager in a later telephone conversation explained that training was delayed as he was in the process of clarifying exactly what should and should not be taught to staff with fire safety procedure. The requirement made at the last inspection that this training be completed will therefore be repeated at this one. In addition, on this visit, it was observed that manual handling training needs updating, which will also be a requirement for the protection of service users and staff alike. The staff have recently received Makaton training but suitable training in challenging behaviour (recommended previously) is still being sought. Staff confirmed that they receive formal supervision on average every four to six weeks and that copies of the supervision notes are given to the workers concerned. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 40 and 42. Tanners Walk is well run and the Managers appear to have a good style of leadership. Policies and procedures are in place to protect service users. The Home is generally safe and service users are happy and protected; however, some environmental work remains to be done to ensure the protection of those who use the service. EVIDENCE: The Home’s Manager has worked at Tanners Walk since 1991 and has occupied the position of Manager since 2000. Records show that he has a RNMH qualification, a City and Guilds 325.3 Advanced Management in Care Award, a NEBS Supervisory Management Qualification and that he is working towards his Registered Manager’s and NVQ Assessor awards. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 22 Staff spoke highly of their managers, describing them as “efficient” and they said that they were listened to by both the management team and the New Era organisation. The Home has a very relaxed atmosphere and service users said they were happy and treated well. Procedures are in place to cover such matters as dealing with bullying, disciplinary procedures. Regular checks are made on the fire alarm system and fridge and freezer temperatures, although it was noted that there were some gaps in the weekly fire tests last summer. This issue has apparently been brought up at a staff meeting and evidence was seen that checks are now back on track. Fire drills have been completed within the necessary periods. At the last inspection, it was remarked on that showers were running consistently too hot and that they therefore needed to be repaired or replaced. New showers have now been obtained and await fitting. The appropriate insurance certificate was displayed in the office. As mentioned before, Tanners Walk has some major problems again with subsidence that, if it continues to damage the structure of the building, may possibly cause the safety of service users to be compromised. New Era are required to keep the Commission for Social Care Inspection informed of progress in this matter. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 X 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 X 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 10 Tanners Walk Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X 3 X DS0000008194.V265827.R01.S.doc Version 5.0 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 4 Standard YA1 YA42YA35 YA42 YA24 Regulation 5 23(4)(d) 13 23(2)(b) Requirement Each person to be provided with updated service user guide. Fire safety training to be 20/02/06 provided for all staff. Update manual handling training. 13/03/06 Update CSCI on a regular basis 25/11/05 on how the Home’s subsidence is being addressed. Timescale for action 20/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA35 YA24 Good Practice Recommendations Consider providing challenging behaviour training to staff. Consider refurbishing the kitchen once subsidence dealt with. 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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 10 Tanners Walk DS0000008194.V265827.R01.S.doc Version 5.0 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. 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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