Inspection on 05/12/05 for 32 South Street

This inspection was carried out on 5th 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

32 South Street 07/08/07

32 South Street 29/08/06

32 South Street 07/06/05

32 South Street 29/11/04

32 South Street 24/05/04

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

CARE HOME ADULTS 18-65 32 South Street Sheringham Norfolk NR26 8LL Lead Inspector Mrs Dorothy Binns Announced Inspection 5th December 2005 10:00 32 South Street DS0000027522.V261922.R01.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 32 South Street DS0000027522.V261922.R01.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. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 32 South Street Address Sheringham Norfolk NR26 8LL 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) 01263 824040 01263 824040 Prime Life Limited Miss Katherine Angela Pye Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19) of places 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nineteen (19) Service Users with a mental disorder excluding learning disabilty or dementia, three of whom are over the age of 65 years, may be accom modated. All new admissions must be between the ages of 18 and 65 years. 2. Date of last inspection 7th June 2005 Brief Description of the Service: 32 South Street accommodates 19 service users with a mental disorder. The accommodation provides 19 single rooms some with en suite facilities on three floors. The top floor consists of a three bedroom flat with its own sitting room and bathroom and a bed sitting room with bathroom. This accommodation is used by those service users who are more independent. The remaining service users live together sharing the communal accommodation. There is a service users kitchen for them to make drinks and a variety of lounges including a smoking lounge and a games room. There is also a very attractive garden. The Home is registered to accommodate those who are under 65 years of age and new admissions will meet this criteria. Because of the previous registration, there are some service users who are older than that and the Home is required to monitor their needs carefully to ensure they are catered for. The Home is in a quiet street in a residential area near to the town centre of Sheringham within reach of the beach and the towns facilities. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine announced inspection lasting six and a half hours. Discussions were held with the manager about the progress of the Home and whether the requirements of the last inspection had been dealt with. Records and policies were examined. Three service users were seen in private and three staff were interviewed. Six service users also returned their survey form to the Commission and their views have been reflected in the report. What the service does well: What has improved since the last inspection? More service users are being offered opportunities and assistance to enjoy activities outside the home. This increases confidence and independence. Individual hobbies are starting to be promoted. The cleaning in the home has improved with a more structured programme for the service users cleaning their own rooms. The tests of fire equipment and fire drills are now being carried out efficiently. Medicines are being looked after more methodically. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 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 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 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): None of these standards were inspected EVIDENCE: None of these standards were inspected 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 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): 6,7 and 9 Care plans are in place for each service user describing the assistance they need from the home. Service users are able to make their own decisions about their lives as much as they are able and have assistance when necessary. Service users are encouraged to be more independent and to take risks as part of their care package. EVIDENCE: Three care records were checked at random. All contained a full assessment of the service users with details about their abilities and needs. It was clear from the records what assistance was needed from staff and a specific action plan was in place for particular needs eg, monitoring diet, creaming skin. Staff monitored their health and progress and wrote full reports every two or three days or as required. Service users are involved in devising the care plan and they are reviewed on a regular basis by the home. However social work and psychiatric reviews are also documented. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 10 Service users confirmed that they made most of the decisions about their lives like whether to go out, stay in their room, when to go to bed and that it was their illness that held them back rather than any restrictions in the home. Most handle their own money though may have assistance to look after it. The manager said that one or two need assistance to go to the Post Office to collect their benefits. Of the money looked after by the home, two records were checked at random against the cash held and found to be satisfactory. Risk assessments are in place though these are mainly to do with the risk of the service user not doing something. For example a risk assessment was seen for someone having a glycaemic attack because of not eating. Strategies are in place to deal with the risk of aggression or neglect and this would be part of the admission process to discuss how this would be dealt with. In terms of service users wanting to do things and the home having to restrict, there are no such worries about the current service users and much of the staff time is spent in encouraging service users to do more and expand their world. One service user said he had to force himself to go on a weekly outing offered by staff because he knew himself it was good for him though his anxieties held him back. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 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): 12,14,15 and 17 There are few opportunities for employment skills or supported work offered by the Home and this should be looked at on an individual level. Activities are going well in the home but more individual work would benefit the service users. Family links are supported and the home makes an effort to help service users retain links with their family. The routines of the home suit the service users who feel their rights are respected. Service users were not enthusiastic about the food and improvements in quantity and delivery are needed. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 12 EVIDENCE: There are currently no service users in employment or sheltered work or in college. This is something the staff would like to look into but so far these opportunities have not been explored nor would many of the current service users be able to take up. Activities in the home are going well. Staff are offering more outings with a weekly jaunt to a coffee bar and some attending a local social club. Ten went out for a meal recently and a group went to a party in another home followed by attendance at a carol concert. Five enjoyed a holiday in Yorkshire. This is good progress. In house there is a pool table which is used in the evenings but some service users are happy to sit about and be quiet. One service user said she did not want activities and had her knitting. Several of the service users are able to go out themselves and use the local shops and facilities. One service user returned from a walk along the beach with her dog which sleeps in her room. However a third of service users returning the survey form said there were not enough activities so clearly there is more to be done on an individual level. One service user is now going bell ringing which is an example of good practice where one service user has been encouraged to find something which he enjoys and builds up his confidence. More of this work through the keyworker system would benefit the service users. There was evidence that staff help service users to retain family links and visit their families. Contact varies with some service users seeing a lot of their family and visiting on a regular basis, others staying in touch by phone with only occasional visits. The manager said that one service user is taken to see his family as they are unable to visit the home. There are no restrictions on visits to the home and one service user said his brother comes to the home and he can see him in private in his bedroom. In terms of friendships outside, service users do meet and make relationships outside the home and those friends are welcome in the home. One friend was seen visiting on the day of the inspection. The daily routines of the home suited the service users with several sleeping late or being private in their room without interference from staff. Some routines were monitored eg whether someone was coming for their meals but otherwise service users felt quite free. All have a key for their door so staff only go in with their permission. Service users knew when they had to clean their rooms and change their bedding and this did not seem to be problem. Smoking is only allowed in one sitting room and the service users knew the rules. There is a problem with the location of the smoking room as it is a corridor through to other rooms and impossible to avoid. The manager will need to take on board current views about smoking and see whether a different room can be allocated. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 13 All three service users when asked about the food had reservations about it. One said it was “adequate - not great” and said there was no milk in the house this morning and that you could not have cereal and toast for breakfast but only one of those. A recent beef pie had been so tough as to be inedible. Another said it was not too bad though sometimes there was not enough to eat. A third said it was “a bit dodgy” and that you could not make your own toast for breakfast so this restricted what you could have. A third of service users answering the survey said they did not like the food. The inspector also saw lunch being served and noticed that there was a choice of a bowl of oxtail soup or one round of prawn sandwich. Service users said you could not have both. Whatever you chose, it looked meagre to the inspector. Staff said a packet of crisps was also allowed but there was no dessert. The menus showed there to be a choice on the menu and staff confirmed that fresh meat and vegetables are used more now. This is an improvement but quantity is an issue which needs to be addressed. The home does not have a cook and the support staff do the catering. This may be at the crux of the matter. The manager did agree to place a toaster into the dining room so that service users could help themselves to toast and this was done during the inspection. 32 South Street DS0000027522.V261922.R01.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 and 20 Service users receive appropriate personal support provided in a private and dignified way by staff and have access to psychiatric support when appropriate. Service users health care needs are being met. Service users are assisted with their medication and protected by the home’s procedures. On this occasion the procedures were adhered to but mistakes in the past point to a review of how medication is delivered. EVIDENCE: In terms of personal support, most service users can handle their own personal care or may just need a prompt from staff. Three people have help from a carer to have a bath or shower and the home has arranged for the male service user to have a male carer to assist. None of these service users need technical aids or equipment to help them. In terms of psychiatric support, the records showed that most service users have a community nurse who is or can be involved in their care and that other services can be contacted if necessary. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 15 The records showed that access to health service facilities was good. There was plenty of references to GP visits, community psychiatric nurses visiting and mental health reviews by the health service trust. Blood tests were mentioned and the staff were monitoring and recording any concerns about diet, sleeping and mood swings. One service user was going to the optician today and the manager reported that two dentists were used in town. Overall health care needs were attended to. The medication records were examined. Two were checked against the tablets held and found to be correct. The returns book showed any tablets not taken and returned to the pharmacist. Controlled drugs are held in a locked box which was not very sturdy in the locked cupboard. A new cabinet is recommended. Most of the service users have their medication looked after by the home. Where the service user looks after their own, there is a risk assessment carried out. There have been continual problems with medication over the months in this home and staff have received training in an effort to ensure good practice. In order to reduce the problems it is recommended that the way drugs are administered is reviewed. For instance, staff wait for the service users to come to them and this may take place over quite a length of time, the staff member perhaps going on to other tasks in between while waiting. This causes a break in concentration and may be the cause of the frequent mistakes. A review of procedures is recommended. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Procedures are in place for service users to bring up their concerns and service users did feel staff would listen to them. Service users are protected from abuse by the Home’s policies. EVIDENCE: The Home’s complaints procedure was seen in the service users’ guide and it contained the commission address. It was also pinned up on the hall door. Service users did say they could approach staff if they had concerns though the inspector did speak up for one service user who was disturbed at night by the boiler. The manager agreed to look into this. The complaints record was seen and had no recorded complaints since the last inspection. Nothing has come to the notice of the Commission. The Home has procedures in place for responding to the suspicion of abuse and understands the local multi agency procedures. It also has a whistle blowing procedure for staff and for dealing with violence. Service users financial interests are protected by a code of conduct which includes a gifts policy for staff. Staff have not received training on abuse and this is recommended in view of the many available local courses. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The service users live in a homely bright and comfortable environment. Some improvements to facilities would benefit the service users. Bathroom facilities are poor and need to be improved. EVIDENCE: The Home is a large detached house in a residential location not far from the shops and facilities of this small coastal town. It has been adapted to allow all service users to have single rooms and for there to be a variety of communal rooms and a residents kitchen. On the top (second) floor there is a flat for three people and another bedsitter with en suite bathroom for those who can be more independent. The premises are bright and comfortable though the smoking room is located in the middle of the house which you have to pass through to move around the house. All visitors to the office have to pass through the smoking room. In view of recent legislation, the Home is advised to relocate this room so that non smokers are not affected. All the service users are mobile and there is no lift. Bathroom facilities could be improved. All the service users have locks on their doors and locked cupboards for their valuables. As a result of the last inspection new pillows have been supplied. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 18 A tour was made of the bathrooms as it had been a requirement of the last inspection for facilities to be improved. The bathrooms were cleaner than at the last inspection but facilities still need to be improved. Most service users use the ground floor bathroom as it has a step in shower. The first floor bathroom is shabby and the spray from the shower over the bath was inadequate. The bath could be used and the water was warm. A second bathroom on the first floor was adequate though there was no shower. The top floor bathroom was very cold as the heater was not working. A service user said this had been the case for some time and he hardly used the bath which was rusty. There was no shower. The service user said he would much prefer a shower and it is recommended that this bathroom is renovated. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 Staffing is satisfactory but more staff support is required in the evenings. EVIDENCE: The rota showed that staffing was satisfactory during the day with three staff on duty until 8.00pm. (Staff do all the catering as well as supporting the service users.) Staff confirmed that if they were acting as the sleeping in staff after a 12 hour shift they worked until 8.30pm but took a longer break in the day. Previously they worked a 14 hour shift. Whilst the change is a welcome move in terms of staff conditions it does leave only one staff on duty from 8.30pm. This reduction of hours since the last inspection when the sleeping in staff were on duty until 10pm.has not been filled. Only one staff on duty restricts what staff can do with the service users especially in relation to uninterrupted work with individuals and may prevent staff from attending adequately to service users mental health needs. The manager is hoping to change the shift system to enable more staff to cover a longer day. Whilst this is what is required especially at a time when the home is working hard to increase the amount of stimulation to service users, this home has been reluctant to address these issues and a requirement has been made. 32 South Street DS0000027522.V261922.R01.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): 39 and 42 The quality assurance system of the home is not analytical nor local enough to show a systematic cycle of planning, action and review reflecting the aims and outcomes for service users. Fire precautions are being taken to ensure service users are safe. EVIDENCE: The organisation has some elements of a quality assurance system but this consists of an open invitation to service users to write their comments into a book. Previously a very short survey was used and recorded nationally (by head office) but this has now been replaced by the comments book. There was no evidence of any analysis of issues raised by previous surveys at a local level and what the home would do about it. A set of standards showing what would be measured in a quality system was not clear. An audit of the building is carried out and a list of jobs was recorded as a result of that audit. However a much more thorough and analytical approach to care practices and to what service users say should be carried out locally with an annual development plan for the coming year addressing the issues that have arisen. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 21 It had been a requirement of the last inspection that fire drills and testing of equipment was carried out regularly and this was checked at this inspection. Fire alarms were shown to be carried out weekly and fire drills were up to date with two a year. The accident book was also checked and completed satisfactorily. No other elements of this standard were inspected. 32 South Street DS0000027522.V261922.R01.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 x x x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 2 x x x LIFESTYLES Standard No Score 11 x 12 2 13 x 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x 2 x x x CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 32 South Street Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x DS0000027522.V261922.R01.S.doc Version 5.0 Page 23 No 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 YA17 Regulation 16(2)(i) Requirement The registered person must ensure that food is provided in adequate quantities for the service users. The registered person must review the bathroom facilities to ensure they are suitable for the service users, are kept in good repair and are heated. The registered person must ensure that suitably qualified staff are working at the care home in sufficient numbers for the health and welfare of the service users. In this instance more staff on duty in the evening. The registered person must establish and maintain a system for reviewing and improving the quality of care provided at the home and supply to the Commission a report in respect of any review. Timescale for action 31/12/05 2. YA27 23(2)(j) and (p) 31/03/06 3. YA33 18(1) 31/01/06 4 YA39 24(1) and (2) 31/03/06 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 5 6 Refer to Standard YA12 YA14 YA16 YA20 YA20 YA23 Good Practice Recommendations Where possible it is recommended that staff assist service users to find voluntary work or educational opportunities. It is recommended that service users are encouraged with individual activities through the development of the key worker system. It is recommended that the location of the smoking room is reviewed to ensure that non smokers and visitors are able to benefit from a smoke free zone. It is recommended that a more sturdy cabinet is provided for the controlled drugs. It is recommended that a review is carried out on the way drugs are given out in an effort to reduce the numbers of mistakes being made. It is recommended that staff are offered the opportunity to attend abuse training. 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 32 South Street DS0000027522.V261922.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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