Inspection on 18/10/05 for 102 Long Catlis Road

This inspection was carried out on 18th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

102 Long Catlis Road 07/10/08

102 Long Catlis Road 08/10/07

102 Long Catlis Road 15/08/06

102 Long Catlis Road 11/08/05

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

CARE HOME ADULTS 18-65 102 Long Catlis Road 102 Long Catlis Road Gillingham Kent ME5 8LF Lead Inspector Sue McGrath Announced Inspection 18th October 2005 10:00 102 Long Catlis Road DS0000064411.V260659.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 102 Long Catlis Road DS0000064411.V260659.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. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 102 Long Catlis Road Address 102 Long Catlis Road Gillingham Kent ME5 8LF 01622 769100 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) MCCH Society Limited Care Home 4 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (2) of places 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11/08/05 Brief Description of the Service: 102 Long Catlis Road is a small residential home, which provides care and accommodation for four people with a physical and learning disability. It is one of a number of homes managed by MCCH Ltd. Twenty-four hour care is provided and members of staff have support and training as part of a larger organisation. The premises are in a residential suburb of Gillingham and local facilities are within walking distance, as is access to a bus route. On street parking is available. The garage of the premises has been converted to provide a range of living and storage space. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 18th October 2005 between 10.00 and 15.00. One inspector was in the home and the main focus of the inspection was on the progress of the home in meeting with requirements made at the last inspection, the general environment and the well being of the residents. During the inspection documentation and records were read, including care plans. A tour of the building was undertaken. Many judgements about the quality of life for residents were taken from observations, speaking with staff, reviewing records and from direct discussion with service users. A high number of the requirements made at the last inspection had not been fully complied with and these remain as requirements. The overall outcome was that the care had not significantly improved and that the environment remained poor. What the service does well: What has improved since the last inspection? What they could do better: Very few of the requirements from the last inspection had been complied with and they remain in force. An action plan is require for all of the requirements to identify when compliance will be undertaken. Realistic timescales need to be provided. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 6 The general environment remains poor and most of the rooms are in need of redecoration. New carpets or suitable floor coverings are still needed throughout. All of the toilets need attention. The home is understaffed and this causes activities to be cancelled and affects the well being of the residents. Limited access to transport also makes this situation difficult. The home has high usage of agency and bank staff. The majority of the bedrooms are below the minimum space required. The issue over the resident with challenging behaviour will need to be resolved in the very near future. Although residents have care plans in place, which are regularly reviewed, service users needs and wishes in terms of community access are not properly assessed and the outcomes and goals are not incorporated into the care plans. As two of the three residents are over 65, the manager should ensure staff have an awareness of the needs of older people. 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. 102 Long Catlis Road DS0000064411.V260659.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 102 Long Catlis Road DS0000064411.V260659.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): 1,2,4 and 5 The home’s Statement of Purpose and Service User Guide do not reflect the current physical environment of the home and do not provide prospective residents and their relatives with the information they need regarding levels of care and the philosophy of the home. Residents do not benefit from having a written contract/statement of terms and conditions with the organisation. EVIDENCE: The manager had been provided with a new Statement of Purpose from MCCH Ltd dated July 2005. Although this document was seen at the last inspection and advice was given at that time, it still does not give a true reflection of life at Long Catlis Road. Several areas in the Statement of Purpose still do not reflect actual practise in the home. It will remain a requirement that the Statement of Purpose is either adhered to or changed to reflect actual practise. Apart from the inaccuracies contained the Statement of Purpose was well presented and was in an appropriate format. The organisation is continues to be developing contracts for all of the residents. These will be assessed at the next inspection. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,and 10 Residents do not benefit from having care plans that reflect their current personal needs; these plans do not address personal goals and achievements and do not always contain up-to-date risk assessments. Residents can be confident that staff will handle personal information held about them properly and that staff will ensure that their confidences are kept. Residents cannot be confident that they are fully consulted or involved in decisions that are directly pertinent to them. EVIDENCE: Care plans had not changed since the last inspection so the above judgement remains. One resident who had a diagnosis of autism and presented very challenging behaviours was at risk because of a lack of information contained within his care plan since there was little guidance to staff as to how best to manage his care. As in the previous report this resident needs to be fully re-assessed and suitable accommodation found. A few risk assessments were seen but these were not very comprehensive and not always current. The manager stated that she had received training in 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 10 completing risk assessments some years ago but would like further training in this subject. Confidentiality was discussed with the manager and staff who all had a good understanding of its importance. The issue of residents accessing their benefits were discussed. This has been an ongoing issue since MCCH Ltd had taken over the management of the home. Although not directly responsible for the problem the organisation have been slow to come to a decision or solution. The residents at this home have not had their bank accounts closed so every effort must be made to ensure the benefits they are entitled to be paid to them. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14 and16 Residents do not benefit from having the opportunity for personal development with their daily living skills or have appropriate level of leisure activities. The residents can be confident the home will provide appetising meals and that they will enjoy a balanced diet offered by the home. EVIDENCE: Current issues with a specific Resident continue to impinge on the lives of the other Residents, in that they are not comfortable in his presence. One of the Residents in particular remains restricted to what he can do because he is afraid, and his quality of life is being affected. The manager is again strongly advised to review the placement concerned and seek an appropriate placement with the Care Manager, to ensure the safety and well being of the other Residents. Opportunities to develop social, emotional, communication and independent living skills in this home were limited. It is accepted that none of the service users would be able to access employment and due to the age group further education is not applicable. However, more could be done to stimulate the residents and make activities 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 12 more freely available. Activities are only taking place during the week, and some planned activities had not taken place for several weeks. One resident enjoys going to church on a Sunday. Problems with transport and staffing levels also impinge on the amount of leisure activities offered. Residents do not currently have a holiday; the manager stated that some days out had been arranged but more needs to be arranged for the residents to enjoy. The home had an open policy on visiting with visitors welcomed t any time. Staff do assist one resident to visit his family. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 21 Service users can be confident that their health needs will be met and that they will benefit from having full access to all professional health care services as required. Service users are protected by the home’s policies and procedures for dealing with medicines. Residents are placed at a disadvantage in that ageing, illness and death issues have not been addressed by the home. EVIDENCE: All residents were registered with a local GP and had full access to healthcare facilities in the local area. Medication was again assessed and advise was given regarding the storage of PRN medications. These also need to be stored in a locked, bolted medical cupboard. Copies of all staffs signatures who administer medication need to be recorded. Senior staff have completed an appropriate course in the administration of medication. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 14 No evidence could be found that the manager had addressed the issue of illness and death and dying with resident or their representatives. This needs to be addressed and recorded on the residents care plan. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Residents are protected by a clear and effective complaints system and also by the home’s robust adult protection policies and procedures. EVIDENCE: The organisation had a complaints procedure in place, which was accessible to the residents. The home had adopted the Kent and Medway Multi Agency Adult Protection Policy. This policy included details on whistle blowing. The home had not received any complaints in the last year. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 30 The residents do not benefit from living in a homely, comfortable environment. The level of cleanliness and infection control procedures needs to be improved to ensure residents live in a safe, hygienic environment. EVIDENCE: The house cannot be classed as homely or particularly comfortable. The lounge area is in the process of being redecorated but staff are having to complete this task within their working day. The narrow door leading to the lounge has been widened to allow wheelchair access but the flooring still needs replacing. The thresholds are now damaged and could cause a trip hazard. The home has been provided with a new table and chairs and the curtains have been replaced. New lights with integral had also been fitted. The both toilets remain in need of upgrading and the flooring also needs to be replaced, as it is stained and had a strong odour. The manager was concerned that the odour was from the floorboards. If this is the case these may need to be replaced also. The obsolete shower in the upper bathroom needs to be removed to reduce the risk of contaminated water flowing back into the main system. This will be a 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 17 requirement. The ventilation fan in the downstairs toilet is broken and needs replacing, this may help with the odour problem. The bedrooms were fairly clean and reasonably decorated. Some are more personalised than other. It was noted in the last report that the washing machine was very old and in a poor state externally. This time the homes washing machine was completely broken and had been out of order for some time. Staff were having to take all of the service user’s and the homes washing to another MCCH establishment. This is not acceptable and adequate washing facilities must be provided. The laundry room, at the rear of what was the garage, remained damp and needed new impervious flooring as highlighted in the last report Although highlighted in the last report powered gloves were still being used. It is strongly recommended that non-powdered latex gloves be provided. Non powdered/latex free gloves should be available for those staff members with confirmed allergies. The manager is advised to obtain a copy of Kent and Medway Community Infection Control Guidelines. All staff are awaiting training in Infection Control. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35 and 36 Residents may be put at risk because not all staff have completed their updated mandatory training. The quality of care and the safety of the residents is compromised because of the home’s inadequate staffing levels. Residents are put at risk because the organisation has not complied fully with its own recruitment procedures. Residents benefit from staff who are appropriately supervised by senior members of staff, EVIDENCE: The manager confirmed that all staff had written job descriptions. It was a requirement from the last report that sufficient night staff were permanently employed as three of the residents had restless night and were likely to wander. This has not been complied with and will remain a requirement. This issues need to be addressed, as it is not possible to guarantee the same agency/bank staff. A recent issue of a resident being poorly and admitted to hospital highlighted the concern, as his first few nights back at the home were covered by an agency staff that had not worked in the home before. Not only was the resident still feeling unwell, he had a stranger to care for him. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 19 Although 75 of the care staff had completed NVQ2 or above some of the mandatory training was now out of date. The manager will be required to provide a training matrix for all staff to evidence what training is required. Staff need training in managing challenging behaviour. Regular supervision is being undertaken by the management team. Two of the staff records were incomplete, as they did not contain current CRB checks. The manager is required to obtain CRB with immediate effect and provide evidence to the commission that these are in place. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 40,42 and 43 The care of residents is compromised by the home’s lack of quality monitoring systems. Residents cannot be confident that the home’s written policies and procedures are kept up to date and reflect best current practice. Residents are not fully protected by the home’s current health, safety and welfare arrangements. EVIDENCE: The manager is currently applying to the Commission to become the Registered Manager. The home does not undertake any quality assurance and this needs to be included in any future plans for the management of the home. The home had copies of all of the policies and procedures written by MCCH. Staff signed to say they had read and understood the policies. The policies need to be signed and dated by the manager and be regularly reviewed and monitored to ensure they still apply to the current situation in the home. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 21 The immediate requirement made at the last inspection regarding the bath hoist and hard wiring had been complied with, however the results of the hard wiring test were only received by the manage on the day of the inspection. When read it was noted that some remedial work was required. The manager must confirm in writing to the Commission when this work has been completed. Records were seen to be stored in a locked cupboard in the lounge. Not all of the taps had TMV fitted and this needs to be addressed. Some of the hot water taps in the bedrooms were only delivering cold water and the pressure was very low so that the water came out at a dribble. This also needs to be addressed. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X 1 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 1 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X 2 1 X X 2 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score 3 2 X 1 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 102 Long Catlis Road Score X 3 2 1 Standard No 37 38 39 40 41 42 43 Score X X 1 3 X 2 X DS0000064411.V260659.R01.S.doc Version 5.0 Page 23 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 Standard YA33 Regulation 18 Requirement The registered person shall,having regard to the size of the care home ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the residents. In that sufficient night staff are permanently employed . This was carried over from the last inspection The registered person shall,having regard to the size of the care home ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the residents. In that the home identify what proportion of staff hours, including the managers, are spent on direct care of service users. Sufficent care hours must be provided to meet the assessed needs of the residents. This was carried over from DS0000064411.V260659.R01.S.doc Timescale for action 30/11/05 2 YA33 18 30/11/05 102 Long Catlis Road Version 5.0 Page 24 the last inspection 3 YA24 23(2)(d) The registered person shall ensure that all parts of the home are kept clean and reasonably decorated. This include decoration and flooring. This was carried over from the last inspection The registered operson shall ensure there are sufficient numbers of clean and hygenic toilets. This was carried over from the last inspection The registered person shall ensure that the premises used meet the needs of the residents in that access to the rear garden is provided for wheelchair users. This was carried over from the last inspection The registered person must ensure that a comprehensive care manager assessment is carried out for the service user who was admitted outside of the homes registration and a more suitable placement found. This was carried over from the last inspection The registered person shall compile in relastion to the care home a written statement which includes all information as listed in this regulation and is relevant to the home. The registered provider shall produce terms and conditions for the security of the residents. The reigtered provider must provides suitable laundry facilities. An immediate requirement was made on the day The registered provided must ensure all staff have current CRB checks DS0000064411.V260659.R01.S.doc 30/11/05 4 YA27 23 30/11/05 5 YA24 23(2)(a) 30/11/05 6 YA2 14.1(a) 30/11/05 7 YA1 4(1) 30/11/05 8 9 YA5 YA30 5(b)(c) 13(3) 30/11/05 19/10/05 10 YA34 19 19/10/05 102 Long Catlis Road Version 5.0 Page 25 11 YA27 23 The obsolete shower in the upstairs bathroom need ot be removed 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 Refer to Standard YA30 YA37 YA6 YA39 YA20 YA14 YA35 YA26 YA26 Good Practice Recommendations It is recommended that non-powdered latex gloves be provided. Non powdered/latex free gloves should be available for those staff members with confirmed allergies. It is recommended that the manager spends a minimum of twenty hours per week in a management role The manager must ensure that service users assessed needs are met, in that recommendations made in speech therapy assessments are acted upon. It is recommended that a quality assurance plan is developed for the home to ascertain the views of users and theor representatives and advicates It is recommended that all staff who administer medication signatures are recorded and that a secure cupboard is obtained to store the PRN mediactions. It is recommended that the full allowance given for residents holiday is actually used. It is recommended that staff be trianed in dealing with Challenging Behaviour It is recommended that the fan in the downstairs toilet be replaced. It is recommended that all taps have TMV and that the water pressure is sufficient to ensure all upstairs sinks have hot water. 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 102 Long Catlis Road DS0000064411.V260659.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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