Inspection on 29/12/05 for 1a Daubeney Gate

This inspection was carried out on 29th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1a Daubeney Gate 20/02/07

1a Daubeney Gate 27/01/06

1a Daubeney Gate 11/01/05

1a Daubeney Gate 10/06/04

1a Daubeney Gate 19/02/04

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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 Daubeney Gate (1a) Shenley Church End Milton Keynes Bucks MK5 6EH Lead Inspector Sue Smith Unannounced Inspection 29th December 2005 11:45 Daubeney Gate (1a) DS0000015054.V267425.R02.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 Daubeney Gate (1a) DS0000015054.V267425.R02.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. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Daubeney Gate (1a) Address Shenley Church End Milton Keynes Bucks MK5 6EH 01908 505245 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) www.macintyrecharity.org MacIntyre Care Mrs Sally Charrington Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2005 Brief Description of the Service: Daubeney Gate is a purpose built home for adults with learning disabilities located in a residential part of Shenley Church End, Milton Keynes. The home is close to local shops and is a short drive from the city centre. The property is owned and staffed by MacIntyre Care Services. Service users of both sexes were being cared for with a range of personal care needs. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over 3.5 hours by Sue Smith, Regulatory Inspector. The Manager was available throughout the inspection. During the inspection a variety of documents and procedures were assessed which included, Careplans, Statement of Purpose, Abuse policies, Complaints records, risk assessments, health and safety documents and procedures and recruitment procedures and documents. In addition, the Inspector spent time with the Service Users and staff in the dining room during lunch, observing practice and interactions. A full environmental tour of the building took place. The requirements and recommendations from the previous inspection report were assessed with most met; some do require ongoing work to ensure they are fully met. As a result of this inspection a further two requirements were made and one recommendation. The Inspector would like to thank the Service Users, staff and management of the home for the welcome received and support in completing the inspection. What the service does well: Service Users are supported to express their views and opinions on the day-today operation of the home. Careplans are being updated to reflect a person centred planning approach, which is Service User led. Risk assessments are in place, which ensure Service Users are able to take appropriate risks and maintain independence safely. Service Users are supported to develop their own menus and participate in the cooking of meals with staff support. Families and friends are welcomed to the home with no restrictions in place. Service Users participate in a wide variety of activities and social events, which support them to reach their full potential. All care and support is undertaken within the boundaries of the Service Users personal preferences, likes and dislikes. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 6 All complaints are actioned within recognised timescales for action. There have been no complaints received at the home or directly to the Commission since the last inspection. Policies for the Protection of Vulnerable Adults are available in the Home; these include the Milton Keynes inter-agency policy and its reporting systems. These are being formulated in a format understood by Service Users. The Home is well maintained providing a homely and relaxed environment for its Service Users. Staff clean the home to a high standard with Service User support. Staff receive training to support them in their roles and support their own professional development. A competent and progressive Manager who is both supportive and professional in her role manages the home. What has improved since the last inspection? What they could do better: Continue working towards providing formats understood by Service Users for such things as abuse reporting, Careplans, complaints and other relevant information. Ensure all health and safety training (this includes fire awareness) is undertaken within the first 6-8 weeks of employment, in line with the Organisation’s guidance on induction. The Inspector believes further action for improvements of systems will be required as a result of the next inspection, due to a number of the previous requirements assessed as action ongoing, this list is not exhaustive and is only a reflection of the documents assessed on the day of this inspection. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 7 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. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 8 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 Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 9 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. The Home provides a Statement of Purpose and Service Users Guide ensuring service Users are supported to make an informed choice about where to live. EVIDENCE: The Home’s Statement of Purpose and Service Users Guide has recently been up-dated to reflect the changed name of the Regulatory body. These documents are provided in both written and pictorial formats to ensure they can be understood by Service Users and significant others. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Careplans are in place that enables staff to appropriately support Service Users, in line with their assessed needs and personal goals. There are several forums where Service Users can participate in the decisionmaking processes of the home. Risk assessments are in place that outline individual vulnerabilities and which contain measures that enable Service Users to live their lives as independently as possible. EVIDENCE: The Home received a requirement at the last inspection to ensure the Careplans be provided in a format that could be understood by Service Users. With the recent change towards providing a person centred approach to care planning and delivery, this work is still ongoing. However the Manager produced evidence of the assessment process taking place to change all Careplans to Person Centred Planning. The foundation work to ascertain aspirations, personal goals and care needs through Life Mapping has been completed and the Home is now working towards developing goal based plans with the Service Users. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 11 In addition to this work the Home has updated its previous system by introducing a user-friendlier file, which also includes pictorial documents that can be accessed by Service Users. Discussion took place with the Manager as to how these could be further reviewed to provide the Service Users with a usable personal file, which would contain relevant information for their personal care and needs. It is hoped this file could then be used as additional and supportive documentation when changing to the person centred planning documentation. Realistically the Manager believes it will take at least another three months to complete the PCP Careplans, they are working hard to meet this target with the support of a communication consultant and the PCP co-ordinator for the Organisation. The Inspector believes the completion of this work needs to be actioned as a priority; a further requirement for the completion of this work by 30/4/06 has been made. The home’s staff ensure the Service Users are central to the day-to-day operation of the home, they are included in making decisions for such things and menus, decoration and refurbishment and the general day-to-day activities of daily living such as cleaning, cooking and activity planning. Regular Service User meetings take place where concerns or future plans for the home and its residents take place, minutes of meetings are held for reference, which were open to inspection. A requirement was made at the last inspection to ensure the use of loyalty cards was reviewed. The Home no longer use the loyalty card system therefore this requirement is met. All Service Users have risk assessments in place, which identify hazards, which could inhibit their independence in the home or wider community. All of the risk assessments are reflective of risk measures that ensure the Service Users are able to take acceptable risks and the amount of staff support that is necessary to maintain the safety of the individual. All risk assessments are subject to review and were found to be up-to-date. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 14, 15, 17. The Person Centred Planning approach adopted by the Home ensures Service Users are given the opportunity to develop and reach their full potential. Service Users are presented with ample opportunities for social inclusion and benefit from good staff support to do so. Families and friends are welcomed to the home ensuring Service Users are able to maintain their relationships. Service Users are supported to develop menus and participate in cooking tasks, which promotes independence and choice while at the same time reinforcing independent living skills. EVIDENCE: The Service User group are supported daily to make decisions and develop their existing skills. A number of day centres, clubs, external activities and educational facilities are accessed to support the Service Users. The staff team demonstrated a sound knowledge of the individual needs and preferences of Service Users, which further supports them. The opportunities to experience Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 13 new things and maintain links with things of interest are paramount to the development of its Service Users. Staff are supportive, ensuring the wider community is accessed regularly ensuring the social inclusion of the Service Users. Families and friends are welcomed to the home with no restrictions in place. Service Users regularly visit old friends at other homes with staff support and generally lead very social and full lives. Menu planning is done in consultation with the Service User group. The menus in place are nutritionally balanced taking into consideration the likes and dislikes of the group, individuals are given the option to choose a main meal to be placed on the menu and then support staff in the preparation of this meal. A variety of meals are offered with alternatives available should the Service User request a change. The Inspector observed staff providing one Service User suffering with a cold, a variety of lunch options to tempt her appetite, when one offering was left untouched a cup of soup was provided to ensure both the fluid and nutritional needs of the Service User were maintained. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19. Service Users needs are outlined in their individual plans, ensuring these needs are met in a manner preferred by the Service User. Healthcare support for service Users is good, which ensures that their health and well-being is promoted and protected. EVIDENCE: All care and support is implemented in line with the personal preferences and wishes of Service Users. Those able to maintain their own personal care are given the opportunity to do so with staff available on request. All care needs and preferences are listed in the Careplan for the individual and are written in a manner that is informative for newer members or relief staff. All Service Users have a section in their Careplan, which highlights any medical needs and appointments with specialist medical services. Staff ensure all appointments are attended with staff providing support as necessary for such things as transport or sitting in during consultations. Daubeney Gate (1a) DS0000015054.V267425.R02.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. A comprehensive and accessible complaints procedure is in place, in a format understood by Service Users and significant others, ensuring they are able to voice their concerns in an appropriate manner. Vulnerable Adults are protected through a range of policies and procedures, which ensure the human rights of the Service Users are protected. EVIDENCE: All complaints are recorded appropriately with records held in the home of all complaints and investigation documentation. In addition to the complaints policy the home have designed a complaints poster in a format understood by it’s Service Users, this is a commendable initiative which is regularly updated to reflect the changes in the staff team. There have been no complaints received at the home or directly to the Commission since the last inspection. The Home have copies of the Organisation’s policy open to inspection, as well as the Milton Keynes Inter Agency Policy for the Protection of Vulnerable Adults. Reporting systems of this inter agency policy is posted in the main office to ensure staff are familiar and able to access quickly. A Service User friendly copy of this information is being formulated; the Inspector recommends this work be completed as a priority. Daubeney Gate (1a) DS0000015054.V267425.R02.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, 25, 26, 27, 28, 29, 30. Daubeney Gate is a purpose built home which ensures the environment is suitable to meet the complex needs of its Service Users. Standards of cleanliness at the home are good, ensuring that Service Users live in an environment that is clean and hygienic, protecting their health, safety and welfare. EVIDENCE: The Home is situated in a housing estate close to local amenities and Milton Keynes City Centre. The home provides single room accommodation for six Service Users with a Learning Disability. At this time the home would not be suitable for Service Users with a physical disability, however provision for the fitting of a passenger lift have been made in the original building plans which will be fitted at such time as the ageing process of Service Users necessitates further adaptations. There are sufficient numbers of toilets and bathrooms to support the needs of Service Users, these are placed in close proximity to Service Users’ bedrooms and are maintained to a high standard with necessary adaptations in place. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 17 All bedrooms are single accommodation and have been decorated and furnished according to the individual’s needs and preferences. Bedrooms were clean and tidy on the day of inspection and reflective of the individual’s personalities. The staff team, with Service User support, cleans the home. On the day of inspection there were no offensive odours and the home was cleaned to a high standard. Laundry facilities are provided to support the needs of Service Users. On the day of inspection, the clothes dryer was awaiting repair; in the interim the facilities from surrounding MacIntyre Care Homes were being used to ensure there was not a build up of wet washing. The drying facilities at the home had been booked for repair, however this would take some time due to the New Year’s festive period. The Inspector was satisfied that the interim arrangements would be suitable until such time as the equipment was repaired. The home provides adequate communal space to meet the needs of Service Users; dining and lounge facilities are pleasantly decorated creating a homely and relaxed environment for the Service Users. There were no environmental issues of concern noted on the day of inspection, with the home maintained to a high standard. Daubeney Gate (1a) DS0000015054.V267425.R02.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): 34, 35. Recruitment procedures are in place, which ensure Staff employed by the Organisation are appropriate for the post applied for, however there were gaps in the information held in the home, therefore potentially leaving the Service Users open to abuse. A programme of training is in place, which ensures the staff at the home is able to provide a professional service to its Users, however some gaps in health and safety training were evident, leaving the Service Users at risk. EVIDENCE: The HR department maintains recruitment information with copies sent to the home; on inspection, verification of CRB disclosures and the individual number are sent to the home through a memo, this did not include verification of a POVA check taking place. In addition, the Inspector noted gaps in C.V.’s with no supporting evidence that these had been followed up with the applicant. The Inspector will notify the Commission’s PRM (Provider Relationship Manager) who is presently working with the Organisation, of these omissions and leave it for them to decide how best to resolve these issues. As the Inspector is awaiting guidance on these issues, a requirement has not been made, however the designated Regulatory Inspector for the home at the next planned inspection will follow this up. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 19 A programme of training for all staff is in place; a record of all training undertaken was open to inspection. A requirement to ensure all staff left in charge of the home have up-to-date fire awareness training; this has been undertaken, however it was noted on inspection of training files that newer members of staff had not received their fire training. On discussing this issue with the Manager, it was ascertained that they had in fact been booked to undertake this training in the New Year, however the gap between employment (in one case 10 months) and the time this training will be received is not acceptable. A further requirement has been given to ensure all staff receive this training within the same timescale as the health and safety section if the induction portfolio is completed, the recognised timescale for this work within the Organisation is 6-8 weeks from commencement of employment. Daubeney Gate (1a) DS0000015054.V267425.R02.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): 37, 42. The home’s Manager has the necessary skills and training to support her in the role, ensuring a professionally run service with high standards of care and support is maintained for Service Users. There are systems in the home that are used to ensure that Service Users health, safety and welfare are protected and promoted. EVIDENCE: The Manager is entering her second year as Manager of the home, in this time she has worked hard to improve the systems in place and meet the requirements and recommendations set during previous inspections. She was found to be open and transparent, offering an open door policy to Staff, Service Users and significant others which has ensured a supportive and professionally run service. A requirement was received to ensure generic risk assessments were put in place; this work has been completed, with all generic assessments now Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 21 available in hard copy as well as being stored in the computer system. These assessments were reflective of a review date of April 2006. C.O.S.H.H. data sheets are available to staff for all products used in the home, these are stored in the home’s office. Weekly fire alarm testing takes place, which is recorded. In addition, the home undertakes weekly emergency lighting testing and recorded fire drills. A fire risk assessment, which has been assessed by the Fire Authority, is in place: this is subject to annual review with a review date reflected. Training in health and safety is offered to all staff through the induction process for the Organisation, unfortunately due to the late booking of fire awareness training for newer members of staff, the home are unable to fully meet this standard. A requirement has been made under this standard and standard 35 to ensure this training takes place within a satisfactory timescale. Daubeney Gate (1a) DS0000015054.V267425.R02.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 3 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 2 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Daubeney Gate (1a) Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 2 X DS0000015054.V267425.R02.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement The Person Centred Planning documentation for Careplans must be completed for all Service Users within 4 months of this inspection. All new staff receives fire awareness training within 6-8 weeks of employment in line with the health and safety training provided during the induction process for the Organisation. Previous requirement not fully met. Timescale for action 30/04/06 2 YA42YA35 23 (4) 29/12/05 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 Refer to Standard YA23 Good Practice Recommendations The work currently taking place to provide a copy of vulnerable adult information in a service user-friendly format is completed as a priority. Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Daubeney Gate (1a) DS0000015054.V267425.R02.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!