CARE HOME ADULTS 18-65
22 Millcroft Warley Road Scunthorpe North Lincolnshire DN16 1QL Lead Inspector
Ms Matun Wawryk Unannounced Inspection 3rd February 2006 09:30 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 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 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service 22 Millcroft Address Warley Road Scunthorpe North Lincolnshire DN16 1QL 01724 282720 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) kirsty.neal@new-era.org.uk None New Era Housing Association Limited Kirsty Anne Neal Care Home 6 Category(ies) of Learning disability (6), Physical disability (3) registration, with number of places 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th August 2005 Brief Description of the Service: 22 Millcroft is a care home providing personal care and accommodation for six adults aged 18-65 years with learning disabilities. Three of these places are for service users who also have a physical disability. It is owned New Era Housing and Support and is situated close to two other homes owned by that Company. The home is located in a residential area close to the centre of Scunthorpe. It is close to local shops, amenities and public transport. The home has its own transport. The home is a purpose built bungalow. All bedrooms are single and have wash hand basins fitted. Bedrooms are decorated and furnished to meet individual service user requirements and preferences. Communal areas of the home are decorated and furnished in a domestic style. Aids and adaptations have been provided as required to meet service users needs. All the service users living in the home are female. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on the 3rd February 2006 and lasted for four hours. Most of the service users have very limited verbal communication skills; therefore the inspector spent time with service users observing activities instead of conducting formal interviews. The inspector spoke generally to the two members of staff who were working in the home at the time of the inspection. Formal interviews were not carried out because of the care needs of service users on the day of the inspection. A tour of the home also took place and a number of service user, training and medication records were examined. What the service does well:
At the time of the inspection the home was clean and tidy. The inspector found the staff to be very friendly and they knew about the care the service users who lived in the home needed. Staff spoken to reported that they enjoyed working in the home. Staff stated that they felt the home was well managed and commented on the approachability of the manager. Staff reported that relatives are made to feel welcome when visiting the home, thereby helping service users to maintain family contacts. Service users are encouraged and supported to access local facilities and amenities in the area. This means service user have the opportunity to get out and about. Individual care programmes for service users are comprehensive and reflect all areas of identified needs. These means staff have access to all necessary guidance to enable them to meet the needs of the service users. The meals in the home are good offering both choice and variety. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 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. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 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 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 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): There had been no new admissions to the home; therefore none of these standards were assessed on this occasion. EVIDENCE: 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Individual care programmes are generally comprehensive and reflect all the service users’ identified needs. Care programmes need to be produced in a different format to improve the accessibility of these for service users. EVIDENCE: 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 10 The inspector examined a sample of two individual service user care records. There was evidence that care plans and risk assessments had been developed from the single care management care plan. The individual plans for one service user was detailed and service user focused. This means staff have all the information they need to care for service user properly. Records and discussion with staff showed the support plans for one service user had not been updated to reflect changes following a significant deterioration in the service users physical health. As a result of this the service user was now much more dependent on staff for all care needs. The registered person must review and amend the service user care programmes to ensure they reflect all current identified needs and care requirements. This is needed to ensure staff have access to all the information they need to support the service user properly. Completed risk assessments were in evidence in both files examined and these had been regularly reviewed. The home utilises a standard risk assessment format for all service users. The inspector was advised that once essential life plans have been fully completed, new risk assessments would be produced specific to the individual service user. This will promote a more person centred approach and support the delivery of more personalised care. Care programmes are currently produced in standard written format and are therefore not fully accessible to service users. Care programmes need to be produced in alternate formats appropriate to the needs of service users. This remains an outstanding requirement from previous inspections and must now happen. None of the service users totally managed their own finances. New Era staff act as appointees for some service users living at the home. All service users had a financial support plan. Records and discussion with staff evidenced some service users had purchased their own beds and had also paid for staff to go on holiday with them. Financial plans did not give guidance for this. The registered person must ensure financial support plans provide a clear audit trail for decision-making. This is needed so that the home can demonstrate arrangements are in place to support effective management of the service users’ finances and to ensure appropriate safeguards are in place. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The personal development, recreational and social needs of service users need to be better provided for. Service users are encouraged to maintain family links and friendships. The meals in the home are good offering both choice and variety. EVIDENCE: Examination of records and discussions with staff identified most service users did not have a structured programme of activities provided. Two services had a limited day care service. Anecdotal evidence indicated some service users had had their day centre time reduced over the past few years. Staff advised the inspector that they regularly carried out activities with service users for example, hand massage and nail care, outings, pub visits and shopping trips etc. The senior carer spoken to stated she was in consultation with the responsible local authority to look at further ways of meeting the social, development and recreational needs of service users.
22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 12 Staff commented that sometimes they were not always enabled to take service users as must as they would like because of current staffing levels in the home. Please also refer to comments detailed on page of this report. The registered person must continue to consult with service users and or their representatives on a regular basis to ensure service users benefit from activity programmes, which reflect the service users individual needs, preferences and capacities. Service users must be provided with a programme of valued and meaningful activities. Staff stated relatives and visitors are made welcome at any reasonable time and records seen confirmed this. Key workers helped service users to maintain family contact by sending cards at significant occasions such as birthdays and Christmas. Thereby helping and supporting service users to maintain family contacts and relationships. Service users are provided with three meals a day and a varied menu was available. Food likes and dislikes were recorded. The inspector spent time in the dining area observing the lunchtime meal. Staff were observed to assist service users to eat in a sensitive manner and service users were not hurried. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Personal support is offered in such a way as to promote and protect the service users privacy and dignity. Arrangements for meeting the health care needs of service users are generally satisfactory. The arrangements for supporting service users with their medication need to be supported by formal medication training for staff. EVIDENCE: All the bedrooms are single occupation this means treatments and examinations can be carried out in private. Care programmes detailed how personal care should be provided. Staff were able to describe ways in which they ensured the privacy and dignity of service users was respected. All service users were registered with a GP. A record of routine eye tests, dental and chiropody checks had been maintained and service user weights were being monitored. The home did not have sit on scales, staff reported that for service users who were unable to weight bear, alternative arrangements were in place to ensure their weight was monitored. Records for one service user, who was none weight bearing were examined, this identified infrequent monitoring of the service user weight. The registered person must ensure support plans set out how often service users weight should be monitored and then ensure this happens.
22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 14 Records examined did not evidence that annual health checks including a review of medication and been sought and provided for all the service users living in the home. The registered person must ensure annual health checks are requested. This is needed to ensure all the health care needs of service users are identified and met. Health action plans had not been introduced into the home. The manager reported that discussions were taking place with the local authority regarding this issue. Care workers administer medication. The home uses the Nomad system for drug administration. Medication administration records checked were satisfactory. There were no controlled drugs in use in the home at the time of the Inspection. Staff had not been provided with accredited medication training. However staff reported they had had in-house training, records examined confirmed this. The need to ensure staff are provided with accredited training was discussed with the manager, it was reported that formal training was shortly to be provided. This is needed to ensure staff have the necessary skills and competencies to carryout this role safely and must now happen. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 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 & 23 The home has a satisfactory complaints procedure and complainants can be assured their complaints will be acted upon. The arrangements for the management of adult protection matters must improve through the provision of further training for staff. EVIDENCE: There have been no complaints made to the home in the last twelve months. A detailed complaint’s was in place. In discussion with the inspector staff reported understanding of the procedure and knew whom to contact to make a complaint and or to raise concerns. This means complainants can be assured the complaints will be listened to and acted upon The home had a copy of the Multi-Agency Adult Protection Procedures and Policies. The home also had a detailed internal adult protection procedure, which reflected the multi-agency procedures in respect of referral and investigation. Examination of a sample of staff training records evidenced that some staff had not had adult protection training. The registered person must ensure all staff are provided with this training. This is needed to ensure staff are able to recognise adult protection issues and to ensure staff are fully aware of their responsibilities and reporting arrangements. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 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 & 30 The home was clean and tidy. The standard of the décor within some parts of the home does the not provide service users with an attractive place to live in. EVIDENCE: The inspector carried out tour of the home. The home was clean and tidy and no mal odours were noted. At the last inspection the inspector noted two bedrooms carpets were in need of cleaning or replacing. The sitting room carpet was marked and stained in places. The inspector was advised that all the carpets had been cleaned but this had not removed all the marks and stains. Although this does not pose a health and safety risk to service users, it does not create a pleasing and welcoming environment for service users. At the last inspection the inspector noted that a broken bed had been left in the rear garden. The bed had not been removed, although the inspector was advised arrangements had been made to have the bed removed. All bedrooms examined were clean and tidy and were furnished and decorated in a homely style. Staff had assisted many of the service users to furnish their bedrooms with a range of personal items to reflect individual choice and tastes.
22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 17 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 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): 32, 33, 35 & 36 Staffing levels are generally satisfactory. The arrangements for supervising staff must improve. EVIDENCE: Staff were very clear about their roles and responsibilities and understood the management and reporting structures for the home. The home maintained two staff on during the day. Staff commented that generally staffing levels were satisfactory. However as previously indicated staff reported they were no always able to take service users out as much as they would like because of staffing levels. On the day of the inspection staff were to busy dealing with service users to spend much with the inspector. There was no evidence to show a formal review of staffing had been carried out, despite records and discussion with staff indicating the dependency levels of some service users had increased over the year’s. Furthermore feedback from staff indicated some service users had had their day service provision reduced, this means some service users are now spending more time in the home. The home did not have a tool for assessing dependency levels of service users. This is needed to ensure informed judgements can be made about the number of care hours needed to meet the needs of service users.
22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 19 Training records showed staff were up to date with all areas of mandatory training. There was some evidence that some staff had had specific learning disability and service user specific training, however this was not the case for all staff. This needs to be an area of development to ensure staff have the necessary skills and competencies to meet the changing needs of service users. The inspector was advised that a revised induction programme for staff had been implemented within the home. New staff will complete equal opportunities training, including disability training; race equality and antiracism training as part of this programme. The registered person must ensure existing staff are provided with this training. This remains an outstanding recommendation previous inspections There was evidence of a commitment to NVQ training. Three support workers held an NVQ qualification and four others had enrolled to complete an NVQ. The registered person must continue the programme of NVQ training to ensure 50 of care workers obtain an NVQ or equivalent. The home had corporate procedures and practice guidance for supervision. The inspector examined a sample of staff supervision records. This showed that supervision was not being carried out as a minimum of six times a year. This is needed to ensure staff receive necessary support and guidance from their managers and must now happen. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 & 43 The management of health and safety is satisfactory. A structured quality monitoring system must be introduced into the home. This is needed to make sure that everyone is consulted about the running of the home and to ensure continuous improvements are made. EVIDENCE: The registered manager was on maternity leave at the time of the inspection; in the manager’s absence a senior support worker was managing the home. The home had a range of mechanisms in place to monitor the quality of services provided including regular audits of the homes environment. However a specific development plan for the home was not available. The registered person must implement a quality assurance programme, which fully meets the requirements of NMS 39. This is needed to make sure that everyone is consulted about the running of the home and to ensure continuous improvements are made. This remains an outstanding requirement from previous inspections and must now happen.
22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 21 There were comprehensive health and safety policies in place for health and safety. Safe working practices were maintained by the provision of training to staff in the form of moving and handling, basic food hygiene, first aid, health and safety and fire safety. Systems were in place to ensure that all the homes equipment up to date. Service contracts/ certificates were in place for portable electrical appliances; fixed electrical systems and water systems. Staff on duty on the day of the inspection, were not able to confirm the date when the hoist and gas systems were last checked. The maintenance check for the fire alarm system indicated the last check was carried out in 2004. staff were not able to confirm whether a more recent maintenance check had been carried out. The home had a fire risk assessment, this was very brief and refers to individual assessments, the inspector advises that a competent person checks the assessment to ensure all required information is detailed. The overall management of the service was found to be satisfactory. However the Commission has not received any regulation 26 visit reports since the last inspection. The responsible individual for the home is required to produce and make available a report under Regulation 26 of the Care Homes Regulations. This is needed to show that the home is being monitored and to meet legal requirements and this must now happen. 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 x 3 x 4 x 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 2 12 2 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x X X 2 X X 2 X 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 18(1c) Requirement Timescale for action 31/03/06 2. YA28 3. YA33 4. YA39 5. YA36 The registered person must provide all staff dealing with service users medication with accredited training. (Timescale of 16.10.03 and 31.11.05 not met) 23(2o) The registered person must ensure that the gardens are safe, well maintained and accessible to all service users. (Timescale of 16.10.03 not met 31.11.05 not met). 18(1a) The registered person should develop a tool to assess dependency levels to inform decision regarding staffing levels. 24(1ab)(2&3) The registered person must develop a quality assurance and monitoring system that meets the requirements of this standard and produce an annual development plan based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. (Timescale of 19.2.04 and 31.12.05 not met). 18 The registered person must
DS0000002873.V264084.R01.S.doc 31/03/06 31/03/06 30/04/06 31/03/06
Page 24 22 Millcroft Version 5.1 6 YA12YA11 6 7. YA6 12(3) 8. YA26 16 9. YA6 15 10. YA19 13(1) 11 YA42YA24 13 12 YA43 26 ensure staff are provided with formal, recorded supervision as a minimum of six times a year The registered person must continue to consult with service users and or their representatives on a regular basis to ensure service users benefit from activity programmes, which reflect the service users individual needs, preferences and capacities. Service users must be provided with a programme of valued and meaningful activities. The responsible person must develop support plans in a more accessible format for service users. (Timescale of 31.3.05 and 31.11.05 not met). The registered person must have two bedroom carpets and the sitting room carpet replaced The registered person must ensure the care programmes for service user A are updated to reflect all areas of current needs and care provision The registered person must ensure (with the agreement of the service user or their representative) an annual health check including a review of medication is requested The registered person must have the fire risk assessment checked by a competent person The responsible individual for the home must produce and make available a report under Regulation 26 of the Care Homes Regulations
DS0000002873.V264084.R01.S.doc 30/04/06 31/03/06 30/04/06 14/02/06 28/02/06 31/03/06 28/02/06 22 Millcroft Version 5.1 Page 25 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 YA14 Good Practice Recommendations The registered person should provide service users in longterm placements with the option of a minimum seven-day holiday outside the home as part of the basic contract price. The registered person must provide all staff with equal opportunities training, including disability training; race equality and anti-racism. The registered person should ensure that training is ongoing so that 50 of care staff in the home hold NVQ 2 3 4 YA35 YA32 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 22 Millcroft DS0000002873.V264084.R01.S.doc Version 5.1 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. 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!