Inspection on 25/10/05 for 16 Cleeve Hill

This inspection was carried out on 25th October 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 but made no statutory requirements on the home.

Other inspections for this house

16 Cleeve Hill 11/09/07

16 Cleeve Hill 23/10/06

16 Cleeve Hill 09/05/05

16 Cleeve Hill 19/10/04

16 Cleeve Hill 21/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOMES FOR OLDER PEOPLE 16 Cleeve Hill Downend South Glos BS16 6HN Lead Inspector Grace Agu Unannounced Inspection 25th October 2005 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 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 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. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 16 Cleeve Hill Address Downend South Glos BS16 6HN 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) 0117 957 0839 0117 970 9301 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Ms Jane Mary Ireland Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 5 persons aged 18 years and over. May include persons aged 65 years and over 9th May 2005 Date of last inspection Brief Description of the Service: I6 Cleeve Hill is a home for 5 people; it is part of the Aspects and Milestones Trust. The home was opened eight years ago as part of a programme of developing residential community care, for former patients of Stoke Park Hospital. 16 Cleeve Hill is a mature bungalow, which has been renovated and extended to provide accommodation on one floor. It is located on a busy road in a residential area of Downend: shops, post office, library and other amenities are approximately two hundred metres away. There are regular bus services to the centre of Bristol and there is easy access to the motorway network close by. The home provides residential care for people with learning difficulties. There are a variety of daily activities for service users which are supported by the staff and day care support services provided by Spectrum, (which is part of Brandon Trust), and the local day centres. The home has recently leased a vehicle in order to enable service users to fully access community facilities. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which was undertaken over seven hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at he home. In addition, the inspection was undertaken to follow up a notification received at the Commission in relation to an incident which occurred at he home. One resident with a medical condition was unfortunately not given her prescribed medication by a health professional. The incident was reported to the appropriate authorities and the matter has been satisfactorily resolved following the appropriate procedure. The resident’s condition is satisfactory. At the last inspection, eight requirements were made; four of the requirements were met. It was disappointing to note that four of the requirements in relation to ensuring that the name, address and telephone number of the Commission for Social Care Inspection is include in the Complaints Procedure, developing quality assurance systems for auditing the quality of service offered at the home, returning unwanted medication to the pharmacy and undertaking a generic risk assessment at home have not been met. Generally the home was clean, warm, well lit and free from offensive odour. The residents were found to be relaxed and looked well cared for in their homely environment. The manager and staff were seen interacting with the residents in a sensitive and dignified manner. Three residents and two staff members were spoken with and a number of records were looked at on the day. What the service does well: What has improved since the last inspection? 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 6 Windows in two bedrooms have been replaced with double glazed ones to ensure added security and warmth for the residents. 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. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. The process of admission of prospective residents is detailed to enable the residents and their relatives to make an informed choice about moving to the home with the assurance that their needs will be met. EVIDENCE: The present residents at the home remain stable. There has been no admission since the last inspection. However, the registered manager is aware of her roles and responsibilities in relation to ensuring that admission of prospective residents is in line with requirements stated in the National Minimum Standards. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. The home ensures that arrangements are in place to meet the identified health care needs of the residents, however, it fails to protect them by medication administration malpractices. EVIDENCE: At this inspection, three care files were reviewed. There is a stable resident group at 16 Cleeve Hill. Information seen in the care files remain detailed and comprehensive in relation to the health care needs assessments, care plans and the support required to ensure that the residents needs are holistically met. One resident has a contract from the council for provision of an additional three hours support every Saturday, bank holiday and when the day centre is closured. One resident spoken with stated that she likes a particular staff member to assist her with some aspects of her personal care. She would usually get up between 7am and 11am. Staffs treat her with respect and would knock on the door and wait for an answer before going in to assist her with personal care. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 10 One staff member stated that one of the residents is usually good with her personal care, the resident would usually wash and dress herself independently however, and she needs assistance and support with bathing. Another resident spoken with stated, “I can dress myself”. The resident requested that male carers do not assist her with personal care, this request is treated with respect and is clearly written in the care file and is communicated to all staff. One staff member was able to give a detailed account of the needs of a resident with complex needs and how these needs are met routinely. The care files have evidence of health professionals visits to include, General Practitioners (GP), Psychologists and district nurses. The Commission for Social Care Inspection received a Regulation 37 notification in relation to a missed dose of medication of a resident by a health professional. This incident was reported to the appropriate authorities and it was satisfactorily resolved. Measures are in place to prevent further occurrence. The manager stated that the resident is occasionally taken to the drop in centre to see the nurse for follow up. There is an out patient appointment on 14/11/05 to see the consultant. All care files reviewed contained individual risk assessments in relation to bathing, walking, going to the shops and using wheelchairs. These and the care plans are regularly reviewed and updated. The home’s medication administration procedure was reviewed. It was noted that that unwanted medication was stored at the home and that handwritten medications on the Medication Administration Record Sheet (MARS) were not signed. This requirement was made at the last inspection and it was disappointing to note that the home is carrying on with the same practice further occurrence in order to protect the residents. The manager must ensure that measures are in place to prevent further occurrence in order to protect the residents. In discussion, the manager stated that all staff members administering medication to the residents have attended Basic Medication Administration training and that she is currently undertaking medication training update with all staff members. The home has a death and dying policy, the manager stated that staff members are aware of the importance of ensuring that information about the residents is kept confidential. One staff member interviewed confirmed awareness of the policies and procedures and where they could be accessed. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. The home provides meaningful activities for the residents, enables them to maintain contact with the local community, families and friends and ensures that residents enjoy good meals at heir chosen times. EVIDENCE: Activities provided for the residents at the home have not changed. Four residents attend various activity sessions provided by Brandon Trust daily and regularly. One resident attends Blackhorse RAC five days a week. The manager stated that all the residents have daily dairies detailing the activities undertaken by them and any other issues that staff may need to know about the care needs of the residents. The dairies are completed by the day care staff and staff working at the home. On the day of inspection, all the residents were seen being taken to attend different outside activities at different times of the day. One resident interviewed stated that she enjoyed her day out. One day services support worker who was visiting the home to take a resident out for the day stated that arrangements are being put in place to organise a more structured community weekly activities for the residents. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 12 One resident spoken with stated that she attends church every other Sunday and participates in completing and enjoys the jigsaw puzzles provided at the home. The residents are also supported to enjoy trips outside the home. One resident stated that she was looking forward to visiting Edinburgh for a day to see Father Christmas. There is evidence of family and friends visits in the care files reviewed. One resident’s sister in law visits occasionally, another resident visits her mother regularly, and another resident receives cards and parcels from parents who live outside the country There is evidence of choice of meals and residents are supported to participate in preparing the weekly menu. The kitchen was found clean; the fridge and freezer temperatures were regularly recorded. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Whilst residents are supported to exercise their legal rights and are confident that the home is able to protect them from abuse the home fails to provide them with sufficient information in relation to complaints procedure. EVIDENCE: There was no recorded complaint since the last inspection. One staff member spoken with demonstrated awareness of how to support resident to complain if they wished to. One resident spoken with stated that she would complain to the manager if she had any complaint. It was disappointing to note that a requirement made at the last inspection for the home to include contact details of the Commission for Social Care Inspection in the home’s Complaint procedure was not met. Another immediate requirement was issued at this inspection with a time scale. The manager is reminded that failure to comply with this requirement could lead to enforcement action. Staff have attended training on Protection of Vulnerable Adults and are aware of the policy and procedure in relation to the protection of the residents from abuse. Staff are also are of the Whistle Blowing policy to enable them to report any malpractices without fear of reprisal. There was documentary evidence that individual rights have been explained to the residents and where residents are unable to make choices or decisions, it was explained how they would be supported to make choices. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 14 The manager stated at a discussion that two new staff members have joined the team at Cleeve Hill. It was disappointing to note that no records were at the home in relation to their recruitment on the day of inspection. The manager stated that the records were at the Aspects and Milestones Head Office. An immediate requirement was made for evidence of satisfactory recruitment documentation that meets the National Minimum Standard to be sent to the Commission within a time scale. The Commission within the time scale set received this confirmation. The home is required to ensure that all staff records must be kept at the home at all times for inspection by the Commission for Social Care Inspection representative. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,25,26 The home has a well-maintained environment where residents feel happy to live however, it fails to protect them by lack of adequate risk assessments. EVIDENCE: The home was found to be clean, warm, tidy and free from unpleasant odours. Residents met at the home looked well cared for and were sitting in the lounge and enjoying each other’s company. It was pleasing to note that two front bedrooms and the front door have been replaced with double glazed windows to give the residents more security, warmth and comfort. One resident spoken with on the day stated that she felt safe at the home. At the last inspection, a requirement was made for the home to undertake a generic risk assessment of all of the areas the residents have access to, this requirement was not met. Another requirement was made at this inspection to 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 16 ensure that residents are protected from potential injuries. The home is reminded that failure to comply with this requirement may lead to enforcement action. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The recruitment procedure of the home offers protection to the resident at the home. There are adequate numbers of staff who are competent to meet the needs of the residents. EVIDENCE: There is a recruitment procedure at the home to ensure that only appropriate, suitable and experienced staff are recruited at the home. One the day of inspection, there were adequate numbers of staff members on duty to meet the needs of the residents. A full report in relation to two recently appointed staff members who had no records at the home is covered in Standard 18. One newly appointed staff member interviewed stated that she was issued a job description to ensure that she is aware of her role and responsibilities. She is currently on induction and working under supervision. The staff member was provided an induction pack which had information on Health and Safety. The staff member also attended Five days training on all aspects of health and safety and one day Values training. The induction training is expected to last for six month. A staff member was noted discussing the needs of residents with one of the newly appointed staff members. The new staff member was given detailed information of the potential challenges that staff may encounter whilst caring for the residents and how to seek assistance if they occur. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 18 At a discussion with the manager, she stated that staff have attended manual handling updates, information on manual handling and residents individual risk assessments are recorded in a folder that is easily accessible to all staff. All staff administering medication to residents have received training. The manager stated that she is currently updating all staff on medication administration. Two staff members have recently completed National Vocational Qualification (NVQ) at level 3, one staff member had completed Competency training which is a detailed training in care designed for people who do not wish to undertake NVQs. The manager stated that the new staff members would commence NVQs after six months induction and probationary period. Other training attended by staff includes Protection of Vulnerable Adults from abuse. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. The home benefits from good leadership and management, however, it’s practices do not fully protect the health and safety of residents. EVIDENCE: 16 Cleeve Hill is a stable home in relation to the category and care of the residents accommodated at the home. The registered manager is well qualified, experienced and competent and has managed the home for many years. On the day of inspection, the manager demonstrated knowledge of her role and responsibility in relation to managing a home with this category of residents. This was evidenced in her interaction and care given to residents with complex and challenging needs. Whilst interviewing the residents, the manager was able to use her knowledge and skills to interpret and explain the 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 20 residents’ responses. Residents responded in the affirmative when asked if the manager treated them with respect and would listen to their concerns. One staff member interviewed stated that the manager is approachable and listens to any concern that she may have. The staff member would report any bad practices to the manager to ensure that residents are protected. One of the new staff members stated that she was made to feel welcome by the manager and all the staff members and that there is a good atmosphere at the home. There are regular staff meetings to discuss the needs of the residents, day to day running of the home and feedback from the manager in relation to medication changes. Staff members confirmed that they have received regular supervision. A staff member was aware of the policies and procedures of the home and where these could be accessed. The fire log book was examined and it was noted that fire checks and fire risk assessments were in date Staff have received fire training on three separate days to include 16/5/05, 30/9/05, 19/10/05.Avon Fire Brigade guidelines on fire safety were noted at the home to enable staff to extract information in relation to fire safety precautions. Risk assessments in relation to various aspects of resident’s care and including assessing the community were present at the home. However it was disappointing to note that the requirement made at the last inspection in relation to undertaking a generic risk assessment at the home had not been met. No satisfactory explanation was provided by the manager in relation to not meeting this requirement. An immediate requirement was issued for this generic risk assessment to be undertaken to ensure that unnecessary risks to the safety of the residents are identified and as far as possible eliminated. The manager is reminded that failure to meet this requirement may lead to enforcement action The manager stated that one of the bedroom doors was not closing properly; she would contact the contract services of the organisation to attend and repair the door to ensure that the resident is adequately protected. The accident book was reviewed and it was noted that that an incident on 8/9/05 involving a minor injury to a resident in a minibus was recorded, followed up and resolved satisfactorily by the organisation. An action plan to prevent further occurrence was noted at the home. The methods used by the home to monitor its services were reviewed. The manager stated that the home had monthly monitoring forms to review staff training (NVQs) diet, residents weight, staff supervision and medication for residents. The manager also stated that the care file overview of all individual residents is checked monthly to ensure that areas of concern are identified and appropriate action taken. The manager would send a letter with a brief questionnaire to the relatives to seek their views about the quality of services 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 21 provided at the home it was also agreed the home develop other ways of monitoring the service and to ensure that it is resident centred. The residents’ records and other confidential information were securely locked away. The home had policies and procedures to include, Missing Persons, Protection of Vulnerable Adults, Health and Safety and Training. 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 3 X X 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 X 3 2 2 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 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. 2. 3. Standard OP38 OP9 OP18 Regulation 13 13 22 Requirement Undertake Generic Risk assessment of all areas residents have access to. Return unwanted medication to the pharmacy. Ensure complaints procedure includes the name, address and telephone number of Commission for Social Care Inspection. Ensure all hand written medication on the MARS are signed and dated. Ensure all records of individuals working at the home are at all times available for inspection by CSCI inspectors. Provide evidence of satisfactory recruitment documentation of recently appointed staff members. Develop a system of monitoring the quality of services that is resident centred. Timescale for action 25/11/05 25/11/05 25/11/05 4. 5. OP9 OP37 13 Schedule 4 Schedule 2 24 30/11/05 31/12/05 6. OP29 01/11/05 7. OP33 30/11/05 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 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 16 Cleeve Hill DS0000003385.V276923.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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