Inspection on 21/10/08 for The Willows

This inspection was carried out on 21st October 2008.

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

The inspector 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

The Willows 24/06/09

The Willows 24/10/07

The Willows 07/02/07

The Willows 22/02/06

The Willows 17/10/05

The Willows 28/01/05

The Willows 11/08/04

The Willows 19/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE The Willows 1 Murray Street Salford Manchester M7 2DX Lead Inspector Adele Berriman Unannounced Inspection 21st October 2008 10:30 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 The Willows DS0000006730.V372899.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 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. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Willows Address 1 Murray Street Salford Manchester M7 2DX 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) 0161 792 4809 0161 708 9481 msandher@aol.com Unity Homes Limited Mrs Mary Tennant Lunnie Smith Care Home 124 Category(ies) of Dementia (124), Old age, not falling within any registration, with number other category (124) of places The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP. Dementia - Code DE The maximum number of people who can be accommodated is: 124 Date of last inspection 24th October 2007 Brief Description of the Service: The Willows is a detached property providing accommodation for up to 124 older people. Unity Homes Limited owns the property. The responsible individual is the proprietor, Mr Sandher, and the registered manager is Mrs Mary Smith. The home is situated in a residential area of Broughton on the major bus routes and within ten minutes drive of Manchester City Centre and internally the buildings are accessible to all. Two car parks provide adequate parking for residents and visitors. The cost of the service is between £373.52 and £476.60 per week. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use the service experience adequate outcomes. An unannounced visit to the Willows on 21st October 2008. This visit formed part of a key inspection of the home. During the visit we spoke to several residents talked to us about their experiences of living at the home. We also spoke to a visitor, members of staff and the registered manager. We looked at a selection of policies and procedures, care planning documents and staff file. We visited several areas of the home including a selection of bedrooms and communal facilities. The registered manager completed an Annual Quality Assurance Assessment (AQAA). The AQAA gave the opportunity for them to tell us what they do well, how they had improved in the last twelve months and their plans for improvement in the next months. The AQAA also gave the opportunity for them to tell us about their policies and procedures and numerical information about the Willows. The information in the AQAA told us the information we asked for. What the service does well: People’s needs are assessed prior to moving into the Willows to ensure they have the facilities to meet the individual’s needs. They have an open visiting policy and relatives and friends are welcomed at all times. Staff demonstrated a good awareness of the needs of the people they support. Procedures were in place that enabled people to raise concerns about the service. An on-going programme of refurbishment provides people with a clean, safe and comfortable environment. People are protected by the recruitment procedures. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 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 The Willows DS0000006730.V372899.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. To ensure the needs of individual’s can be met an assessment is carried out before people are admitted to the Willows. EVIDENCE: We saw that since we last visited the service had reviewed their Statement of Purpose to include up to date information about the service. They told us that prior to moving into the home a pre admission assessment was carried out. The purpose of this assessment is to ensure that the service has the facilities to meet the needs of the individual. We saw that pre admission assessments formed part of people’s personal files. They told us that they planned to develop their pre admission assessment to include more information about people’s values, beliefs, feelings and activities. In addition they planned to make amendments so that the assessment included The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 9 information about people’s mental capacity. Assessments of people’s needs and wishes should be detailed to ensure that they receive the care and support they require at all times. They told us that people, where possible, were invited to spend time at the home before making a decision to move in. The Willows does not provide intermediate care facilities. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To ensure that people receive their prescribed medication accurate records must be maintained. EVIDENCE: We saw that each person living at the Willows had an individual care plan. We looked at several of these care plans. The information on the care plans varied in the amount of detail written about the individual’s needs an wishes. For example, one care plan contained detailed information about their personal presentation. It stated ‘enjoys wearing perfume, make-up and jewellery. Prefers hair long and is able to style it herself.’ Other care plans that we saw contained little information about how a person’s needs were to be met. For example, one care plan stated “assist to clean teeth regularly and undertake oral care when required.” Further information needs to be available as to what actual support the person needs when being The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 11 assisted. Failure to have detailed information recorded about people’s needs and wishes may result in their needs not being fully met. We saw one care plan that contained information about restricting a person’s choice. It stated ‘please bring (X) down to the dining room if they are quiet and co-operative. There was no other information available to inform staff of how to encourage the individual to access the dining facilities within the home. It is essential that all people who live at the Willows have the opportunity to access all communal facilities. Care plans gave the opportunity to record how people express their sexuality. Not all of these sections had been completed. It is recommended that information about individual’s preferred personal presentation is recorded so that people’s needs and wishes relating to their personal presentation are met. Risk assessments for falls, the use of bed rails, moving and handling and nutrition were in use. Monitoring records were also available to monitor people’s health and wellbeing. For example, we saw monitoring charts for weight and pressure relief. We looked at the pressure monitoring records for two people. Staff had recorded at 9am that the people were out of bed. At 11.45am there was evidence to demonstrate that staff had visited the room to check on the welfare of the residents or their seating arrangements for pressure relief. Both people were unable to access their call bell to request assistance from the staff if needed. One of the residents confirmed that nobody had been to see them. We asked her how she would alert the staff if she needed to and she told us “I suppose they get to know” when she needed them. It is essential that people have regular access to staff to ensure that their needs can be met at all times. We discussed with the manager the need for improved care plans. They recognised that changes needed to be made and demonstrated to us a new care planning system that they were implementing within the service. A member of staff told us that she was participating in changing the care planning format. The staff member demonstrated a good knowledge of the people that she was supporting and a good knowledge of what information was needed in the revised care plans. We spent some time watching staff interacting with people around different areas of the home. The amount of interaction between the people who use the service and the staff team varied in different areas of the home. We saw some areas with lots of positive interaction taking place and it was clear that positive relationships had been developed. Other areas had less interaction and stimulation available for people. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 12 Since our last visit the manager of the service had reviewed and updated the service’s medication policy. Where possible medication was administered from a Monitored Dosage System (MDS). We saw that medication was stored appropriately in several areas around the home. However, spectacles and sets of false teeth were found in the cupboards in one medication room. The senior nurse on duty was unable to identify whom the spectacles or teeth belonged to. We looked at the medication procedures on one area of the home. Medication Administration Records (MAR) supplied by the pharmacist were in use to record what medication was being administered, and were found to be accurate. We carried out an audit of controlled drugs that were in use in one area of the service. We found incorrect information recorded in the Controlled Drugs register. The register recorded that there were two units of a particular medication than there actually was. Other records told us that one unit had been used and not recorded and the other unit could not be accounted for. It is essential that accurate records are maintained at all times to ensure that people are receiving the medication that has been prescribed for them. We saw the MAR of one person who had been prescribed medication on an as and when needed basis. Staff told us that the person was unable to tell them when they needed the medication. There was no information available to inform staff of any signs or indicators of when the medication should be administered. This information should be recorded to assist with people receiving their medication when they need it. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People would benefit from having more opportunities to take part in activities that meet their assessed social, recreational and cultural wishes. EVIDENCE: There were two activity rooms and a relaxation room with sensory type equipment available. The activity rooms were equipped with craft making materials and pictures that people had painted, puzzles and games. We saw that newspapers were available around the home. We saw few activities taking place around the building. We visited one lounge at 10.45am and all but one person was asleep. A member of staff told us “its like that nearly all day” and that “it can be a bit boring for them sometimes.” Staff said that activities were available for people a couple of days a week and that some people liked to play dominoes. Entertainers visit on a monthly basis. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 14 They told us that they had recently appointed an activities co-ordinator to work in one particular area of the home. The manager told us that they were aware that more activities needed to be made available for people and that they were in the process of arranging this. Activities should be made available to people that are varied and suit their preferences and capacities to provide a stimulating interest. They told us that they planned to explore the possibilities of creating a games room for people to access. Regular visits are made by local church representatives to meet people’s religious needs and wishes. These visits include supporting people in taking communion. They had an open visiting policy and visitors were welcome at any time. They told us that they if required they could provide people and their relatives with information about local advocacy services. Meals were prepared and served from two kitchen areas around the home. One person was seen having a late breakfast at 11.15am of toast. The toast had been prepared several hours earlier and had been kept in a food warmer. It is recommended provision is made for residents to have freshly prepare food whenever they choose. This would help promote mealtimes as a pleasurable experience. People who we spoke to during the visit told us they were happy with the food served at mealtimes. When we visited, the menu stated that it was steak and onions for lunch and corned beef hash for tea. Staff told us that there were always alternatives meals available. Pureed meals were served in both areas of the home. We saw in one area that the meals were served with all foods pureed together and in the other area, each food was pureed separately to enhance the general presentation of the meal. It is recommended that all foods are pureed separately to promote mealtimes as a pleasurable experience. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures were in place that enabled people to raise concerns about the service. EVIDENCE: They had a complaints policy, a copy of which was available at the two entrances of the home. They told is in their AQAA that the policy had been reviewed since we last visited. They told us that all complaints about the service were recorded in a complaints log. The Willows had received two complaints since we last visited. They told us that both complaints had been resolved within 28 days and that both complaints had been upheld. We spoke to the relative of a person who lives at The Willows. They told us that staff were very responsive and available to answer any queries. Since our last visit they had reviewed and updated their policy on safeguarding people. They told us that all staff had received awareness training in safeguarding adults. Four referrals had been made under Salford Social Service’s joint agency safeguarding procedures. Not all of these investigations had been concluded, The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 16 The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An on-going programme of refurbishment provides people with a clean, safe and comfortable environment. EVIDENCE: We saw that all areas of the home were fully accessible via passenger lifts. We visited several bedrooms. We saw that people had personalised their bedrooms with their own effects. Communal areas were comfortably furnished with seating to meet the needs of the residents. Bedroom doors were lockable. In one area of the home not all staff had access to override keys to open bedroom doors in an emergency. All staff should have instant access to bedrooms so that they are able to respond immediately in the event of an emergency. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 18 We saw several doors wedged open. This included the small room allocated for people to smoke in. Wedging doors will result in them not shutting when they are required to do so. They should take advice from Manchester Fire and Rescue Service on appropriate equipment to wedge doors open. CCTV cameras were situated around one of the entrances to the home for security purposes. The environment was clean and tidy. Sluice facilities were available around the building for the management of infection control. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are deployed to meet people’s needs. The recruitment procedures protect people. EVIDENCE: The registered manager, carers, senior carers, registered nurses and ancillary staff were on duty to meet the needs of people when we visited. They had a recruitment procedure that ensured that appropriate references and Criminal Record Bureau checks were sought prior to a person starting their role. We saw the files of five recently recruited staff members and all contained evidence that completed Criminal Record Bureau checks and written references had been received. We saw that they were using agency staff to ensure that sufficient staff were available to meet peoples needs. They told us that they were currently having a recruitment drive to recruit to current vacancies. We spoke to a member of the care staff who had recently been recruited. They told us that they were in the process of doing their NVQ (National Vocational Qualification) level 2 award and that they had received training in fire procedures and moving and handling. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 20 We spoke to a senior member of staff who had completed their NVQ level 3. they told us that they felt very supported in their role by the registered manager. We spoke to an external NVQ assessor who was visiting the service. They told us that the management of the service was very supportive in the NVQ process. They told us that 18 people were currently undertaking their NVQ award and some staff were also taking a course in basic skills in literacy and maths. They told us that staff had a received awareness training in safeguarding adults, infection control and medication administration. They told us that was planned for senior nursing staff to gain the Dementia Training Certificate which focuses on the recognition of different forms of dementia care. In one area of the home there was little interaction seen between the staff team and people who use the service. Other staff were seen to interact well with people and it was evident that good relationships had developed. We saw staff interacting verbally, by gesture and touch. Some staff we spoke to demonstrated a good awareness of the people they were supporting. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is run in the best interests of people. EVIDENCE: The registered manager has many years experience working in a nursing and social care environment and had completed her registered managers award. They told us that they were in the process of sourcing dementia training. The manager demonstrated a good awareness of the needs of the people who knew the service and was clear in what improvements the home needed to make. We saw that there were clear lines of accountability throughout the staff team. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 22 They asked people what they thought about the service by questionnaire. Peoples views of the service were also sought through an established resident’s committee. They told us that they we planning to implement a new quality assurance system within the next 12 months. Policies and procedures were in place to support people in managing their own monies and ensuring people’s money and personal effects are safeguarded. A recording system was in place to record accidents. We saw that they also monitored all of the falls that people had experienced on a monthly basis. The service should in their monthly monitoring record any action taken following the monitoring exercise. We saw that they were recording incidents that had occurred when people challenged the service. We discussed with them the needed to activate safeguarding procedures and inform us when these situations occur. Policies and procedures were in place to support the health, safety and wellbeing of people. A maintenance person was employed to carry out regular maintenance checks around the building. The Willows DS0000006730.V372899.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 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no 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 OP8 Regulation 12 Requirement Systems must be in place to evidence that people have regular access to staff at all times to ensure their safety. Records of the administration of controlled drugs must be accurate to ensure that people receive the correct medication. Timescale for action 21/12/08 2. OP9 13 14/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Care plans should be further developed to record the needs and wishes in people’s day to day life. A record of what signs and indicators may be demonstrated by a person if they require medication on an as and when (PRN) basis. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 25 3. OP9 The spectacles and sets of false teeth stored in the medication cupboards should be returned to their owners. Medication cupboards should not be used as storage for people’s personal effects. 4. 5. OP12 OP15 The opportunities for people to access recreational, social and cultural needs and wishes should be developed. People should have access to freshly prepared food at all times. People should be given the opportunity to have their pureed foods served separately to improve the appearance of their meal and promote mealtimes as a pleasurable experience. 6. OP21 The service should take advice from Greater Manchester Fire and Rescue service on appropriate ways of holding doors open. 7. OP21 All staff should have access to people’s bedrooms at all times in the event of an emergency. The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 The Willows DS0000006730.V372899.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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