Inspection on 17/07/07 for 42a-b Lowther Park

This inspection was carried out on 17th July 2007.

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

42a-b Lowther Park 19/06/06

42a-b Lowther Park 14/09/05

42a-b Lowther Park 18/05/05

42a-b Lowther Park 06/12/04

42a-b Lowther Park 17/08/04

42a-b Lowther Park 09/03/04

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Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Parkside

Park Lodge

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

CARE HOME ADULTS 18-65 42a/42b Lowther Park Kendal Cumbria LA9 6RS Lead Inspector Ray Mowat Unannounced Inspection 17th July 2007 08:45 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 42a/42b Lowther Park Address Kendal Cumbria LA9 6RS 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) 01539 731159 01539 735202 martyn.strange@oakleatrust.co.uk www.oakleatrust.co.uk The Oaklea Trust Mr Martyn Strange Care Home 7 Category(ies) of Learning disability (7), Physical disability (1) registration, with number of places 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The home is registered for a maximum of 7 service users to include; up to 7 service users in the category LD (Learning disabilities) up to 1 service user in the category PD (Physical disabilities) 19th June 2006 Date of last inspection Brief Description of the Service: 42A/42B Lowther Park is situated on a residential housing estate on the outskirts of Kendal, Cumbria. The premises are two halves of a semi-detached property, which has been adapted to create one dwelling. The home is owned by Impact Housing Association and operated by the Oaklea Trust, a not for profit charitable organisation, specialising in providing services to people with a learning disability. It can provide a home for up to seven people with a learning disability, one of who may have a physical disability. It is approximately two miles from the amenities of Kendal town centre, with local shops and amenities within walking distance. There are two ground floor bedrooms and six upstairs rooms, one of which is a staff sleep-in room, which doubles as an office. There are adequate bathing and toilet facilities on both floors, including two toilets and a fully accessible walk-in shower on the ground floor and two bathrooms with traditional baths and a toilet on the first floor. The communal space in each side of the home is identical, comprising a lounge, kitchen/diner and small laundry room. There is ramped access to the front door and accessible garden and patio areas to the front and rear of the home. The current fees charged range from £592.66 to £640.60 with additional charges for sundry personal items such as toiletries. Information about the home is supplied to people in an easy read format and previous inspection reports are displayed in the home. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this inspection visit I spent time with residents in the communal areas of the home. I also spent time with the manager discussing the running of the home and examining the records required by legislation. I talked to the care staff on duty during the day in addition to receiving surveys from them. I also had contact with other professionals involved with the home and family representatives. What the service does well: What has improved since the last inspection? People are supported at key times to help them make informed choices. Activities for people with complex needs have increased and have been beneficial to them. Policies and procedures, which explain to staff how to do things, have been looked at to make sure they are up to date. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 6 The manager now has a record in the home of when security checks and references have been completed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems and procedures in place support people through the admission procedure and ensure their needs and aspirations can be met. EVIDENCE: There are clear policies and systems in place that guide staff through the admission procedure and ensure a comprehensive assessment of people’s needs takes place prior to them moving into the home. The new assessment forms part of a person centred plan that reflects individual’s needs and aspirations. Through this process the manager and staff work closely with the person and make sure they have all the information they need to make an informed decision about moving into the home. Through a thorough risk assessment process people’s choice and independence are promoted with suitable safeguards in place. All the people living in the home have been referred via a care management assessment. This is in addition to the home’s own assessment and any specialist assessments from other agencies involved. This ensures the Person Centred Plan is holistic and provides a continuity of care and that staff are suitably trained. During this process compatibility with other people already living in the home is assessed and if the environment is suitable for them. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The development of person centred plans and a person centred approach by staff ensures people’s individual needs and personal goals are responded to and they are involved in all aspects of home life. EVIDENCE: Staff are in the process of transferring information from their current needs assessment and care plans into a new person centred plan format called “My life, my choice”. These include an informative pen picture and life story, which is written in the first person and gives a valuable insight into significant events in people’s lives and what is important to them. Further sections are focussed on how people like to live their lives and the level of support they require in addition to practical information about health and personal care. The information is comprehensive and is cross referenced to risk assessments and to short, medium and long term goals that people have identified. The goal/aim is recorded including how it will be achieved and who will be involved. The progress is also monitored which is good practice. The way the plans are 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 10 recorded reflects the value based approach of the staff that respects the person’s individuality and choices they have made. The person centred plan is developed from the comprehensive assessments that are completed during the admission procedure as well as staff working closely with the person and people important to them to gather the relevant information. Staff are receiving training to help them with the new planning process in addition to the manager mentoring staff through the process. Health action plans are also produced and a health facilitator identified from the staff team, who support people to access relevant health services they require and ensure pertinent information is recorded and shared with significant others. There was evidence of regular reviews taking place, which involved the person themselves, family representatives, care managers and other professionals. Progress was monitored against goals and new actions identified. This is good practice ensuring the effectiveness of services is evaluated and changing needs are recorded and responded to. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People enjoy a fulfilling lifestyle both in the home and in the local community. EVIDENCE: Through the development of detailed care plans and now person centred plans detailed records of people’s preferences in all aspects of their lives are recorded. This includes details about the daily routines that are important to them, the levels of support they require to undertake activities or leisure pursuits and their plans and aspirations for the future. Opportunities for personal development are provided both in the home and through attending a local day service. All the people attend the service Monday to Friday although one person has two afternoons per week when they get one to one support from staff from the home to go personal shopping and visit their family. The day service provides people with the opportunity to experience a wide range of vocational and educational activities of their choice. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 12 At home people are involved in all aspects of home life such as washing the pots, tidying and cleaning bedrooms and dealing with their laundry. Some people have shown an interest in gardening so with staff support are growing vegetables and tending to the garden. Activities are also provided in the home for people with more complex needs such as aromatherapy and music therapy, which have been well received. Other regular activities enjoyed include going for walks, day trips, visits to the local pub for a drink or a meal. One off concerts and shows always prove popular and are arranged periodically throughout the year. Other more sedentary activities enjoyed include hand massage, foot massage, nail care, music, watching films and playing with a games console. People are either planning or have already planned annual holidays or day trips for the summer including a holiday abroad. Some people like to visit family and stay with them, which they are supported to do. Holidays are planned with people ensuring the holiday meets their individual needs a good example of this is someone who has a preference for a series of day trips rather than overnight stays. A new system has been introduced to help people chose their meals and do the shopping. Individual preferences are recorded on a daily basis with separate meals provided as requested. This level of choice is good practice. Staff monitor choices made and encourage and support people to maintain a healthy and balanced diet with special dietary requirements recorded. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On the whole individual healthcare needs are well documented and monitored by staff to ensure they can access appropriate services when required. EVIDENCE: Preferences with regard to personal and healthcare support are well documented with regular reviews taking place to identify changing needs. Based on discussions with them staff have a good understanding about individual needs and maintaining dignity and respect when completing personal care tasks. During this visit I observed staff offering choices to people and providing unobtrusive support. All aspects of healthcare are recoded in the health action plans with a health care facilitator identified who supports people with appointments etc. This could be a staff or family member. They take a lead role in liaising with the GP, community health team or other relevant health professionals ensuring people get access to the service they require. Information in the health action plan and person centred plan is detailed and makes sure a consistent approach from staff. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 14 I checked the contents of the medication cupboard against the medical records held by the home. There is a record of all medication coming into or leaving the home and the medication that is required to be administered. PRN medication is held separately and guidelines have been agreed to guide staff when and how to administer. There was a discrepancy between the medication held and the records, which was discussed with the manager. It was agreed more frequent monitoring by senior staff is recommended to ensure early identification of any errors or discrepancies. Part of the person centred plan records people’s wishes upon illness and death including any specific cultural or religious needs. This ensures staff deal sensitively with such issues and are aware of what is important to the person and their family at this difficult time. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well trained and have a good understanding of their role and responsibilities to ensure people are safeguarded and their concerns or complaints are responded to appropriately. EVIDENCE: No formal complaints have been made since the last inspection. A POVA investigation is currently taking place, which was appropriately referred, by the home. They also took appropriate action to ensure people were safeguarded when the allegation was made. Staff receive suitable training through induction with regard to the complaints policy and procedure and safeguarding adults training. Refresher training is also provided at appropriate intervals. People living in the home receive detailed information in alternative formats to ensure they are aware of their rights and how to raise a concern or complaint. When informal concerns are noted they are recorded in a communication book or personal file. This ensures relevant people are aware of the concern and it is dealt with consistently and is resolved in a timely manner. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 26, 28, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Lowther Park provides a safe and comfortable home that is well maintained and decorated and furnished to a good standard. EVIDENCE: The home provides suitable communal and private space for the people living there. It is maintained, decorated and furnished to a good standard with an ongoing programme of repairs and renewals planned that will maintain this standard. The programme records work that has been completed and other planned repairs and renewals. Each individual has a budgeted programme for the replacement of furniture and decoration of their own rooms. Some decorating has been completed and new furnishings purchased that create a pleasant and homely atmosphere where people feel safe and comfortable. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 17 People’s bedrooms are personalised by them and reflect their individual tastes and interests. They are suitably furnished wit people bringing in their own furniture and fittings as they choose. They provide a comfortable and private space where people can pursue their own hobbies and interests. New garden furniture has been purchased for the rear garden, which provides a pleasant outdoor area where people can enjoy the good weather and have a bar-b q. After consultation it has been agreed to label cupboards with a picture or symbol, which will help people to be more independent around the home, which is good practice. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a full compliment of staff that are suitably trained and have the skills and experience to meet people’s assessed needs. EVIDENCE: There is now a full compliment of staff with all vacant posts now filled, agency staff have not been used since April 2007. A relief member of staff has also been appointed, which has improved the continuity of care when the regular staff are absent. In addition regular staff now have some spare capacity to pick up extra shifts to cover these absences. People living in the home are getting more involved in the recruitment process for new staff, which has been successful. A training need has been identified to support people to get more involved in the formal assessment and interview process, which is good practice. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 19 Subsequent to a request from someone living in the home a picture board of photographs of the staff team has been developed, so that people know which staff are on duty or coming on duty on the next shift. This has proved very helpful to this person and helps to alleviate some anxiety. I examined the staff rota for the current month and found absences were being covered appropriately. There are 233 hours of care provided each week, with a minimum of one staff on each side of the home. Staff are also timetabled to be in for key times when people need support with their preferred activities. This is monitored by the manager to ensure people’s needs are being met appropriately. I spoke to staff on duty and examined staff files, which confirmed that supervision was taking place in the required timescales and that they were getting “good support from the manager and senior team”. Training and personal development was discussed as part of supervision as well as clarifying people’s roles and responsibilities and the policies of the home. There were no up to date annual appraisals held on file, which should now be completed for all staff. Training records examined recorded the training staff had completed, what refresher training was due and the training that had been planned. This covered all the core subject areas. There was also a programme of planned specialist subject training circulated by the training department, for which the manager could make referrals. The Trust has robust recruitment and selection procedures that safeguards people and ensures suitably trained and skilled staff are employed. The manager will forward an up to date staff list confirming when checks are completed when the current recruitment process is completed. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed effectively and in the best interests of the people living there. EVIDENCE: The manager is both suitably qualified and experienced to manage the home. He continues to provide clear leadership and good support to the staff and the people living in the home. He works closely with the senior staff in particular, to ensure the smooth running of the home. Regular supervision and team meetings are taking place as well as regular meetings with the people living there, which ensure people are involved in all aspects of life in the home. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 21 These different forums provide valuable feedback in addition to more formal consultation regarding the quality of services provided. Trustees visit the home on a regular basis and monthly management visits and audits also take place that also focus on gaining feedback from people and therefore monitoring quality. This level of consultation and monitoring is good practice and provides people with opportunities to contribute to the running of the home and the organisation and to measure their success. The Trust also holds what they call “Customer Partnership Meetings” every two months. This gives people the opportunity to raise any issues or concerns, which are then acted upon by the management team. There have been examples of people accessing independent advocacy services in addition to being represented by their family members. There is an Annual Development Plan and Business Plan for the home that is produced based on feedback from both the formal and informal monitoring systems, which reflects the needs and aspirations of the people living in the home. This is produced in an easy read format using signs and symbols as well as typed print and is made available to people and their families or representatives. A household file is used to document records required by regulation for the protection of residents. These included water temperatures, fridge/freezer temperatures, Legionella checks and the fire log, which were now all in order, however there were some gaps in the recordings earlier in the year. As a result of ongoing monitoring the manager is developing a risk assessment in relation to the use of one of the showers, as there is a variable temperature gauge, which can override the temperature limits. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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 3 3 3 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 X 3 3 X 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA36 Good Practice Recommendations Monitoring of medication stocks and administration records should take place more frequently to quickly identify discrepancies or errors. Annual appraisals should now be completed with all staff to review their performance and set personal development targets. 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 42a/42b Lowther Park DS0000022686.V343642.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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