Inspection on 13/05/05 for 40 Venner Avenue

This inspection was carried out on 13th May 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 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

40 Venner Avenue 25/06/08

40 Venner Avenue 14/09/07

40 Venner Avenue 13/12/06

40 Venner Avenue 28/09/05

40 Venner Avenue 15/02/05

40 Venner Avenue 17/06/04

40 Venner Avenue 12/02/04

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Dalewood Respite Care

Orchard,The

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Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 40 Venner Avenue Northwood Cowes Isle of Wight PO31 8AG Lead Inspector Liz Normanton Unannounced 17 May 2005 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 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 Stationary 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. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 40 Venner Avenue Address 40 Venner Avenue, Northwood, Cowes, Isle of Wight, PO31 8AG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01983 293782 01983 293782 Islecare97 Ltd Mrs Pauline May White Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15/2/2005 Brief Description of the Service: Venner Avenue is a small residential group home for adults with learning disabilities. The home is a detached bungalow located in a quiet residential area of Northwood, within walking distance of local shops and the main bus route between Newport and Cowes. There are four single rooms for service users and a communal lounge and dining/kitchen. Gardens are to the front and rear and can be used by the residents. Parking is on the front drive and the road at the front of the house. There is both level and ramped access to the front and level access to the rear. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector visited the home on a mid-week day. The manager and several staff were at the home on the inspector’s arrival and one resident was at home. The other residents were at day centre services. The home’s previous senior staff member was visiting. What the service does well: 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. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 7 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 standard(s) 1,2 Prospective service users would be able to access information about the home to enable them to make an informed choice about where they want to live. An assessment of potential service users would be undertaken to ascertain their aspirations and wishes. EVIDENCE: Islecare provides the home with a Statement of Purpose which gives details of the philosophy of the home and the services and facilities it provides. Islecare also provides the home with a service user guide outlining details of accommodation provided, specialist services, complaints procedure etc. The inspector found that the service user guide requires updating to reflect that CSCI now undertakes, inspections the current document says NCSC. The section for contracts had no information in it. Details of staff qualifications were also not available. The service user guide and Statement of Purpose are not available in alternative formats to written language. The home has not had any admissions for several years, however the manager was aware of the need to undertake a needs assessment, and drawing up a risk assessment and care plan for new residents. The inspector viewed two residents’ care plans and found them to contain all the necessary information to care for individuals. Residents in the home are unable to contribute to their 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 8 care plan, staff have worked closely with the residents for many years and are able to ascertain their views and wishes from facial gestures and body language and will update their care plans to meet their changing needs. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 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 standard(s) 6,7,9 The residents of the home would not be aware that they have care plans, which reflected their needs and wishes however there are plans in place. Residents in the home have high dependency needs and have limited ability to make decisions about their lives. Staff have excellent communication skills and are able to ascertain the wishes of residents. The residents are vulnerable adults and need support out in the community they are always escorted. They live a very dependent lifestyle and the opportunity to take risks with regards to promoting independence does not present itself. EVIDENCE: The home has a key-worker system and each resident has a care plan, which is updated six monthly. The staff also do quarterly reports on each resident which then informs the care plan which is amended accordingly. The inspector found that residents at the home have not had the opportunity in their developing years to make major life decisions and have learned to become reliant on others for help and assistance in all areas of decision 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 10 making. The staff have built up an understanding of the residents’ needs and wishes over the years and help them with their decision-making. The manager and staff have undertaken risk-assessments for residents and these are written into their care plans and focus more on the risks presented by individuals’ care needs i.e.: moving and handling/ behaviour management. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 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 standard(s) 14,17 The opportunity to go out and about into the community has been restricted considerably due to the high dependency care needs of one resident taking priority over the needs of other residents. Residents are offered a good range of meals and a healthy diet. Meals are eaten sitting up to a table in the kitchen with staff, and meal times are unhurried. EVIDENCE: The manager and staff informed the inspector that they, and the residents, had not been out on an outing since December 2004. The reason for this being that one resident has deteriorating health, which means they require two-toone support. The manager and staff are beginning to feel isolated within the home and also believe that other residents needs are not being met and that the residents are bored, and as a result of this they are displaying some negative behaviours. The manager informed the inspector that the residents had not been on holiday for over nine years, this is due to lack of financial incentives to the staff team, plus their family commitments preventing them going away for long periods. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 12 Meals are prepared in the home’s kitchen, which is also the dining area. The inspector observed the making of the tea-time meal, which on this occasion was a beef casserole with fresh cabbage and mashed potato. The meal smelt wholesome and looked appetising. The menu is planned over a four week period this is done by the care staff, taking into consideration the likes and dislikes of the residents. If a resident does not like what has been cooked, they are offered an alternative. Residents are not able to take part in menu planning. The inspector viewed the menu and found it to offer a varied healthy diet, which would meet the cultural needs of the residents. Two residents require their food liquidising, staff informed the inspector that they have tried different ways of presenting meals but that residents have shown a preference for it to be liquidised together. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 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 standard(s) 18,19,20, Residents are well cared for and they receive the individual personal support in the way they prefer. The health and welfare needs of residents are met by an established staff team. Residents are not able to take their own medication but are protected by the home’s medication procedures. EVIDENCE: The inspector observed the staff and manager interacting with the residents and found their approach to be sensitive, patient and relaxed. One resident has high dependency care needs and her health and care needs were monitored throughout the day. The inspector observed the manager taking her temperature and monitoring that it was not dropping to dangerously low levels. Preventative measures were in place, i.e. fire on in the living room, resident kept warm with blankets. Each resident has a care plan to inform staff of their care needs. Personal support is provided in the privacy of the residents’ bedrooms or the bathroom. Staff informed the inspector that they do knock on residents’ bedroom doors. There was no opportunity for the inspector to observe this practice and residents were unable to confirm if this was accurate. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 14 Staff informed the inspector that residents got up and went to bed as they choose. There are no set bedtime routines, they stated that residents generally wake early and go to bed early. Residents at the home are dependent on the care staff for all aspects of their care. Residents’ care needs are understood by the long established staff team. Care plans are in place and were viewed by the inspector. The manager informed the inspector that the care plans are reviewed quarterly. The manager informed the inspector that residents have annual health checks. Residents are unable to self administer medication and rely on staff to do this for them. Residents are unable to give verbal consent to the taking of medication. All staff are trained in giving medication. The home has a medication policy and procedure. The manager orders medication on a monthly basis. Blister packs are provided by the pharmacy. Medication is kept in a locked cupboard. There is now a separate lockable box for the storage of controlled drugs. The staff sign the MARS sheets to record that medication has been taken or refused. The administration of controlled drugs is recorded in the controlled drugs register. Written details of all medicines and their side effects are available on file. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 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 standard(s) Standards assessed at the last unannounced inspection EVIDENCE: 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 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 standard(s) 24,26,27,28,30 At the time of the inspection the inspector found the furnishings in the lounge to be old fashioned and there was evidence of wear and tear to many items. The carpet is worn and has a hole in it, which could lead to trips. Other areas of the home were found to be homely, comfortable and safe. Residents’ bedrooms were decorated and furnished to reflect their individual personalities. The bathroom and toilet facilities in the home meet the needs of the residents. Residents have access to two communal areas within the home and the garden. The home was found to be clean, hygienic and free from odours. EVIDENCE: The lounge has a large patio window at the rear of the house, which does not provide a great deal of natural light, which makes the room look dark and dreary. The furnishings are very out-dated. The display cabinet dominates one wall and is showing signs of wear and tear, there was a drawer handle missing and it is very dated. The carpet was showing signs of wear and tear and has a hole in it, which is in the middle of the room. The nest of coffee tables is in serious need of replacing, or restoration, as they are scuffed with varnish 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 17 peeled off. The curtain rail has been fitted badly leading to it being lopsided; it is also coming away from the wall. The suite is in good condition and is comfortable however in the inspector’s opinion the colour, which is lime green, clashes with the dark bottle green carpet. The rest of the home is clean, comfortable safe and well lit. The kitchen area was extremely clean and well furnished and offered a pleasant area in which to have meals. The home is situated in a residential area and is in keeping with the other properties and is approximately ten minutes walk from the nearest bus stop and public house. The post office is approximately fifteen minutes walk away. The entrances to the home are accessible by wheel chair with a ramp to the front door and to the patio window. The manager informed the inspector that the home meets with the local fire service and environmental health requirements. The home does not have a planned renewal programme for fabric and redecoration renewal. The manager has to put request in to Islecare as required. Each resident has their own bedroom. Bedrooms are well decorated and residents have their own furniture. Rooms were personalised to reflect the individual’s interests. Decoration and furnishings in the bedrooms are chosen by staff. Three of the bedrooms have hand basins; one room is too small to install a hand basin. The manager informed the inspector that the resident without the hand basin in their room would more then likely flood the room if it was possible to install one. Three of the bedrooms are lockable but residents do not have keys, as they would not be able to use them. One bedroom does not have a lock. The home has one bathroom, which is fitted with a toilet, bath with hoist seat and a walk in shower. There is also a separate w/c which can be used by residents. Residents have access to a lounge and dining/kitchen in addition to their own individual bedrooms. The gardens are large and the rear garden provides a safe secure area in which residents can relax. The inspector was shown photographs of the garden when it was well presented with flowers bedded out in borders, hanging baskets, well maintained lawns etc, however on the day of the inspection the garden was in need of some attention. Visitors to the home can meet privately with residents in their bedrooms. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 18 The premises were seen to be kept clean and systems were in place to prevent the spread of infection. Laundry facilities were situated in the garage and the floor was a nonpermeable surface. The garage is in need of structural repair and the manager informed the inspector that South Wight Housing are going to undertake the repairs. There are no hand washing facilities in the laundry the manager informed the inspector that soiled clothes are disposed of. The home’s freezer is also located in the garage, there is a thermometer in the freezer to check temperatures and these are checked daily and recorded. The COSHH cupboard is also situated in the garage with the COSHH notice on display. Islecare provide the home with policies and procedures re infection control. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33, Residents at the home are well supported by an established staff team who are aware of their roles and responsibilities. Due to the high dependency care needs of one resident staff have been unable to meet the care needs of the other residents fully. EVIDENCE: The inspector talked with staff who informed her that they had received job descriptions at the start of their employment. The staff team is well established with the longest serving member having been there for seven years. The manager confirmed that all staff have copies of the General Social Care Council (GSCC) code of conduct. Staff are able to discuss their training needs in supervision and at yearly appraisals. All staff are have completed and passed NVQ level 2. Two staff members are currently undertaking NVQ level 3. The inspector found that the staff were pleasant and welcoming and that they took care of the residents. The staff team are committed to caring and this was evident to the inspector in her observations. The staff have the necessary knowledge/experience of learning disabilities, the manager stated that all staff have had undertaken LDAF training. The home does not currently employ any trainees. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 20 At the time of the inspection the home was experiencing low staffing levels. The senior staff member has been transferred to another home following a risk assessment due to pregnancy. There are staff vacancies which add up to 52.5 hrs. The staff team have been working additional hours to cover shifts. The manager stated that staff are feeling tired and run down. An agency worker is employed to cover sleeping-in duties, the same person does this to ensure consistency of care. The home operates three shifts and there are always two staff working on each shift. The home has good relationships with other professionals who come into the home to provide specialist services. The chiropodist visits every 4-5 weeks the Learning Disability Nurse visits the home monthly to see one resident. The staff team is all female which does not reflect the gender composition of the residents, as there is a male resident living in the home. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, The residents of the home would not be able to understand the concept of quality assurance and rely on the manager and staff to ensure that they are well cared for. EVIDENCE: The residents all have severe learning disabilities and are unable to read/write and do not have verbal communication. Feedback about the service provided is usually obtained from parents of the residents. Islecare undertake a satisfaction survey once a year. CSCI provide the home with questionnaires for relatives. Staff observe residents’ body language and facial gestures to gauge residents’ views. The home has a resident satisfaction survey on file, which has Makaton symbols on the document however this has not been implemented. Three residents receive an annual review at the day centre. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 22 The inspector assessed that the home has policies and procedures in place to ensure the staff meet the day to day running of the home and the care needs of residents. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 x x x 1 x x 3 Standard No 31 32 33 34 35 36 Score 3 3 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 40 Venner Avenue Score 3 4 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x x x H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 24 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 YA 1(2) Regulation (5)(c) & 6 (a) Requirement Timescale for action 31-08-05 2. 3. YA 14 YA 24 (10) (12) 18 (a) 23 (c) 4. YA 33 18 (a) The service user guide needs updating, it should contain a contract. The service user guide should be regularly reviewed and revised. It currently says that NCSC are the inspection body, this needs changing to CSCI. The home should be staffed 31-08-05 adequately to enable residents to access activities. Islecare to replace lounge carpet 31-08-05 due to wear and tear. Curtain rail to be repaired and fitted correctly. The coffee tables to be renovated or replaced.The home to have in place a yearly maintenance renewal plan. There should be an increase in 31-08-05 staff on shifts during the day from two to three to reflect the changing needs of one of the residents and to prevent a negative impact on the other residents. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 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 YA 24 Good Practice Recommendations Islecare to consider updating the furnishings in the residents lounge area to provide a brighter more homely environment which better reflects the age group of the residents. 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Mill Court Furrlongs Newport Isle of Wight, PO30 2AA 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 40 Venner Avenue H55_H04_S12549_40 Venner Avenue_V218537_170505_Stage 4.doc Version 1.30 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!