Inspection on 05/09/06 for 162 Wellington Hill West

This inspection was carried out on 5th September 2006.

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

Other inspections for this house

162 Wellington Hill West 27/07/07

162 Wellington Hill West 03/10/05

162 Wellington Hill West 09/05/05

162 Wellington Hill West 16/11/04

162 Wellington Hill West 07/04/04

Similar services:

Radfords

Honeybourne House

32 Beaumont Way

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

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

CARE HOME ADULTS 18-65 Wellington Hill West, 162 Henleaze Bristol BS9 4QP Lead Inspector Karen Walker Key Unannounced Inspection 5 September 2006 09:30 th Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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 Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wellington Hill West, 162 Address Henleaze Bristol BS9 4QP 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 9859918 0117 9699000 The Brandon Trust Mrs Louise Helena Westlake Care Home 5 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (1) of places Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate persons aged 45 years and over. Date of last inspection 3rd October 2005 Brief Description of the Service: 162 Wellington Hill West is operated by the Brandon Trust and is registered with the Commission for Social Care Inspection (CSCI). The manager is Ms Louise Westlake. The home provides care to 5 residents aged 45 years and over in the learning disability category. The categories of registration are: Learning Disability (LD) 4, Learning Disability over 65 years (LD(E)) 1. The residents have lived at the home for many years and the Trust have taken the decision to extend and adapt the property to better suit the aging residents needs. Residents have complex communication difficulties. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Discussions were held with the two staff members on duty and the inspector met with all five residents one of whom was able to make positive comments about his home. Records were examined in respect of residents, the running of the home, health and safety and staff training. A brief tour of the environment was undertaken and one resident invited the inspector to view his room. Residents pay a rent of £790 per week. Personal expenses of £18.80 are used to purchase extras such as hairdressing, holidays and day trips. What the service does well: What has improved since the last inspection? Care plans and associated risk assessments have improved and the residents’ contracts are now up to date and include a user-friendly version of a ‘places to live agreement’. This agreement is in pictorial as well as written form and includes pictures of residents that live in Brandon Trust homes. This ensures a sense of ownership and a better understanding for residents. There was evidence to suggest that residents are supported where possible to make decisions about their lives. All of the requirements made at the last inspection have been met. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 6 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. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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 Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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): 2,5 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents’ needs are fully assessed and met. They now benefit from a jargon free ‘contract’ outlining the terms and conditions of living at the home. Residents now receive basic understandable information that includes what they can expect to receive for the fee they pay. EVIDENCE: There are currently no vacancies. Bristol Social services assessments are in place, these cover: • • • • • • • Education and training Family/social contact Cultural/religious needs Physical health Mental/emotional health Self help skills/risks Communication needs Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 9 The assessments link into the homes care plans and there are regular reviews taking place. One of the staff members on duty carried out a monthly care plan review with her Key- Person and was able to discuss assessed needs with the inspector. There have been no new admissions to this home. Contracts are now in place and residents benefit from an additional document entitled ‘Places to live agreement’. This is in pictorial as well as a written format and has pictures that the residents are able to recognise and understand. Staff confirmed that they had talked through the agreements with residents with some success but not all were able to sign their agreements. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents are involved in the planning of their care and where able can make decisions about their own lives and wishes. Residents are supported to take risks to enable them to live an independent a lifestyle as possible. EVIDENCE: Through case tracking it was noted that at least two of the residents had up to date care plans and risk assessments. Care plans reflected need and the level of support to be given Whilst mobility plans for one person had been reviewed it is recommended that they be rewritten as there have been many changes regarding this persons mobility and support needs. It is recommended that all care plans and risk assessments that require significant updating are rewritten to ensure all information remains relevant and current. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 11 This was discussed with one support worker who was aware of changing personal needs and growing staff support. Risk assessments for the two people case tracked were also current and had been reviewed. Staff were aware of any assessed risks and knew how to support residents. There was evidence to suggest that residents are supported where possible to make decisions about their lives. One of the residents was happy to invite the inspector to view his room. He said ‘I chose my stuff it’s nice, I like my room’. He also confirmed he had a contract and added ‘my face is on it’. Staff confirmed that residents were always a part of their planning meetings and were supported to contribute. One staff member said that through a meeting one resident told staff of his wish to gain employment. He is now enrolled in college on a ‘life skills course’ and will receive support from his named worker in the hope of securing a job in the future. Staff confirmed a ‘key-worker’ system was in place, which enables staff to establish special relationships and bonds and work on a one to one basis with individuals. One support worker said ‘ I feel I’ve built up a special relationship and we get on really well’. All residents have a named worker at their day care establishments and they also attend the planning meetings to help support residents. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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): 12,13,15,16,17, Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents have the opportunity to take part in appropriate activities and are able to maintain and build new links with family and friends. They are a part of their local and wider community where there rights are respected in their daily lives. A healthy diet is offered and meals are enjoyed. EVIDENCE: ‘Choices for learning’ provide a day service to all residents’ and staff said they all enjoy attending. It was clear that the service is reviewed and adequate records of the review kept. All of the residents’ require support with communication and the staff said ‘choices for learning’ facilitate these needs. Records show that staff also attended review meetings and one was held yesterday which one staff member said was very well attended. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 13 Care plans identify the residents’ choice to participate in household tasks i.e. cooking and making drinks. One resident made a request to gain employment at his planning meeting. He is being supported to attend a college course to build new skills to help him with employment skills and choices. He is to be supported on a weekly basis by his key-worker. Staff confirmed that residents are supported to become a part of their local community by using local facilities. There were outings and local visits planned throughout the diary and staff confirmed residents were often out at the local pub for lunch. One resident said, ‘Im going to skittles today’. Whilst staff support residents to get ‘out and about’ it was noted that due to mobility deterioration one resident could no longer use staff vehicles. There had been a ‘near miss’ incident where this resident nearly fell from a car; this was reflected in a risk assessment. The inspector was told that this person almost missed out on a holiday due to the lack of availability of a suitable vehicle that can safely support wheelchair users. It is strongly recommended that the home secure a vehicle for the use of people with disabilities. Staff confirmed that residents’ relationships with friends and family were supported. One staff member said ‘as a result of a recommendation made at a previous inspection to involve family in the writing of a ‘my wishes’ plan, new family contacts have been made and its working really well’. Visits were seen recorded in the diary and in the daily records. The new places to live agreements confirm that visitors are welcome. Residents’ rights are respected and responsibilities recognised in their daily lives. Staff were observed speaking to residents in a friendly but respectful way and there were clearly positive relationships forged. Residents preferred form of address was recorded and post was opened with the resident to whom it was addressed. The pre inspection questionnaire and a sample menu plan evidence that the menu is varied and nutritious. The care plans include safe and healthy eating plans with regards choking and likes and dislikes. One resident looked in the fridge and said, ‘chicken tonight for tea, nice food’. The fridge was in good order and foods covered and dated. The kitchen was clean and tidy. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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): 18,19,20,21 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents receive personal support in a way in which they require and their physical healthcare needs are also met. Medication practices are satisfactory and there are adequate polices and procedures in place. Loss and bereavement is handled well and documentation in place to ensure the wishes of residents after death are respected and followed. EVIDENCE: Residents were all dressed in their own individual style all looking clean and tidy. One resident said ‘I look nice’. Care plans reflected their needs and wishes with regards personal care and staff members were aware of this. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 15 Specialist support and services were accessed where necessary this was evidenced by documentation and was confirmed by residents and staff. There was evidence to show that there was also input from the district nurse and the continence advisor as well as dietician and community nurse. There was chiropody input in and various assessments were in place regarding hearing therapy. The manager said at the last inspection that the Occupational Therapist had input into the placing of the handrails around the home. There is adequate equipment available for residents and the physiotherapist had signed some of the risk assessments related to mobility. Some of these were in need of being rewritten for clarity. It was noted that one persons ‘wishes in the event of their death’ had been recorded. Although it was agreed that this resident had limited understanding of the concept of death this was written respectfully and appropriately. A staff member confirmed that all residents now had ‘their wishes’ in place and information had been gained from family members where possible. Sadly one resident has suffered a bereavement and two staff members attended a ‘loss and bereavement’ training day in order to better support him. One support worker who attended the training has written a ‘support plan’ which staff feel has been beneficial. Psychology input has also been requested to gain extra support. Staff members confirm that as the visits from the family member were on a set day of the week that day was now filled by staff providing one to one support. A staff member said ‘the resident is being supported to chose a plaque and flowers to provide a visual memorial and a place where he can visit’. The medication administration sheets were examined and a sample balance of ‘as and when’ (PRN) medication checked. All were correct at the time of inspection although there was a slight error regarding the recording of one medication this was put right at the time of checking. There were adequate policies and procedures in place to support staff and residents in the administration of medication. Medication reviews take place appropriately and this was evidenced in the individual records. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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): 22,23 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents are protected and feel that their views are listened to and acted upon. EVIDENCE: There are no protection issues or referrals made at the time of this inspection. There are the appropriate protection policies in place including ‘No Secrets’ in Bristol DOH guidance available and the staff on duty knew where to find it. Protection training was discussed and it was confirmed that staff had attended training provided by Bristol City Council and had found this useful. Various scenarios were discussed and it was evident that the staff knew when to seek help regarding a serious complaint or protection issue. The complaints procedure was available on display in the office and each resident had a brief copy in their planning for life packs. One resident said, ‘I tell staff things if Im not happy, no problems’. It was noted that resident meetings take place and the minutes show that residents are able to make their views known. There have been no complaints made since the last inspection. There is a compliments book in place also and it was noted that a day care worker made positive comments about the home. It is suggested that this book be kept in the entrance porch to allow ease of access. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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): 24,30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents live in a comfortable safe environment that is clean and hygienic. EVIDENCE: The first thing noted about the environment was the unsteadiness of the portable ramp leading to the front door. This made a loud noise when stood on and although did not move ‘felt’ unsafe. This must be particularly frightening for those residents with poor mobility. It is recommended that other options be explored or the ramp somehow secured. Staff confirmed that most of the ‘snagging’ had been finished including the crack in the bathroom wall. In general the home now meets the needs of the current resident group and the two residents that require ground floor bedrooms have them. Alterations have been made to ensure they are as safe as possible. Staff confirmed the environment was better as they had easier access to a hoist and only those residents that were able needed to use the stairs. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 18 All residents smiled or responded positively when asked if they liked the changes made to their home. One resident who used to sleep on the ground floor and has moved upstairs said, ‘It’s nice up here; look at my things, I like it’. The home was found to be clean and tidy at the time of inspection. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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): 32,34,35 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents are protected by a robust recruitment procedure and well-trained staff who are able to meet the residents assessed needs. EVIDENCE: Discussions were held with the staff on duty and records confirm that they have completed the necessary statutory training as well as training sessions suited to meeting the needs of the residents. Key-workers on duty were able to describe the needs of their Key-people and how they are best supported. This was also evidenced in the daily records and monthly care reviews. Staff members confirmed that training needs and requests were discussed at 6 weekly supervision sessions. These records were not examined in the absence of the manager. Both staff members on duty also confirmed they had an annual appraisal. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 20 The Brandon Trust has a robust recruitment policy and all the necessary documentation relating to employees is kept at HQ. Staff confirmed that Criminal Record Bureau (CRB) checks were sought in respect of them prior to employment and that references were also sought. Any records kept in the home were not examined in the absence of the manager. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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): 37,39,42 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents’ benefit from a well run home where they are able to make their views known. Residents’ health and safety is promoted and protected. EVIDENCE: The manager has a national vocational qualification (NVQ) in management and has completed her Registered Managers Award (RMA). A senior support worker is also completing her RMA. The manager is a well-established member of the team and staff confirm she is approachable and will listen to ideas. Records show and staff confirm that regular staff meetings take place. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 22 The Brandon Trust has put quality assurance and quality monitoring systems in place. The Service Development Manager visits the home on an unannounced basis every month and a copy of the findings sent to the CSCI. The fire logbook was examined and whilst it was mostly up to date it was noted that one staff member hasn’t carried out regular fire drills. It is recorded that the last drill for this person was carried out in October 2005. Fire equipment checks should be carried out on a monthly basis and records show the last check took place in June 2006. There are many policies and procedures in place to safeguard and protect residents. Records show and staff confirm that they have undertaken all necessary statutory training including, health and safety, food hygiene, COSHH, first aid, fire and protection training. The manager ensures safe working practices and has ensured all staff are trained in moving and handling techniques and that the appropriate equipment is available. Staff confirmed that they moved furniture around in one bedroom to ensure access to the room with the hoist in case of emergencies. There are relevant risk assessments available and all accidents and incidents are fully recorded. The CSCI receive notification of any incidents that affect the wellbeing of a resident. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 4 3 X 3 X X 3 X Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA6 YA13 YA24 YA42 Good Practice Recommendations Rewrite all care plans and risk assessments that require significant updating to ensure all information remains relevant and current. It is strongly recommended that the home secure a vehicle for the use of people with disabilities. Secure or find an alternative ramp leading to the front door. Care must be taken to ensure all fire checks are up to date and all staff receive adequate fire drill practice. Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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 Wellington Hill West, 162 DS0000026646.V296461.R01.S.doc Version 5.2 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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