Inspection on 30/06/05 for 50 Cherry Orchard

This inspection was carried out on 30th June 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

50 Cherry Orchard 27/06/07

50 Cherry Orchard 09/12/05

50 Cherry Orchard 11/03/05

50 Cherry Orchard 26/08/04

50 Cherry Orchard 20/01/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Cherry Orchard (50) 50 Cherry Orchard Highworth Swindon Wiltshire SN6 7AU Lead Inspector Bernard McDonald Unannounced 30 June 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. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cherry Orchard (50) Address 50 Cherry Orchard Highworth Swindon Wiltshire SN6 7AU 01793 765090 01793 765090 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) White Horse Care Trust Ms Rachel Baxter Care Home 5 Category(ies) of LD Learning disability 5 registration, with number LD(E) Learning dis - over 65 1 of places SI(E) Sensory Impair over 65 1 Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 11 March 2005 Brief Description of the Service: 50 Cherry Orchard is a home in Highworth offering accommodation and care to five adults with a learning disability. The home is one of a number of homes managed by the White Horse Care Trust. The home is located in Highworth and is situated close to local shops and community amenities. All service users have the benefit of single bedrooms. There is a large enclosed garden to the rear of the property with a seating and recreational area. The home is normally staffed with a minimum of two staff on duty throughout the waking day with additional staff at peak times. There is no waking night staff. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was completed over five hours. The inspector met with four service users and six staff. There was opportunity to meet with service users in private, although the inspector was unable to communicate effectively with three service users. All service users care plans were inspected together with risk assessments and health and safety procedures. The inspector viewed all areas of the home. The requirements from the last inspection had been met. The manager was not on duty on the day of the inspection but one of the support staff was available to provide information throughout the inspection programme. What the service does well: This is a service that can clearly demonstrate how the needs of service users are being met at the home. Opportunities are provided to enable service users to exercise choice in activities and areas of daily living. There is clear evidence of improvement in outcomes for service users and that the home is run for the benefit of the people who live there. Involving one service user in helping to choose staff ensures service users views are considered in staff recruited to the home. The service user stated they liked the course and was clearly proud of their achievement. There were clear records to demonstrate the health safety and welfare of service users are being safely met. The home was clean tidy and free from any odour. One service user did comment that they liked their room. When the staff team was asked what the home does well the reply was “ we take care of the service users very well” The inspector endorses this statement. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 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 standard(s) 2, 5 Procedures are in place to ensure service user needs are assessed prior to admission. The home needs to ensure that service users fully understand the terms and conditions of their stay. EVIDENCE: There have been no service users admitted to the home since August 2002. Previous inspections have found the home has good procedures for introducing prospective service users to the home. This includes obtaining a community care assessment on the needs of any service users who may be referred to the home. Discussion with staff confirmed opportunities are also provided for the service users to visit the home prior to admission. The inspector examined the contracts of all the service users. The contracts specified the charge for the service and the contribution required by service users. Terms and conditions between the home and the service users were also in place. A representative of the White Horse Care Trust and a representative of the service user had signed the contract. To enable service users to more fully understand their contract, the Trust has developed an abridged version of the contract using symbols, text and pictures. Four of the contracts had not been signed or dated to demonstrate the contents had been explained to service users. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 9 Developing an abridged version of the contract demonstrates a commitment from the service to enable service users fully understand the terms and conditions of their stay at the home. It is recommended this commitment be put into practice. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 10 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, 8, 9. The home can demonstrate how service users care needs are being met and that opportunities are provided to enable service users to exercise choice in all areas of daily living. EVIDENCE: The inspector examined the care plans of all service users. Following a requirement made at the last inspection all service users care plans had been reviewed in the last six months. The care plans covered areas of personal care, choice, communication, cultural needs, health care and relationships. Annual individual plans are in place and identify service users strengths, needs, likes and dislikes. The plans provide details on service users individual goals and what action is required to enable service users achieve their goals. Examination of the plans demonstrated goals were being reviewed and achieved. There is evidence to demonstrate service users involvement in the development of the plans, goals and actions. The home operates a key worker system and discussion with staff demonstrated a clear understanding of the needs of service users and awareness that goals and actions for service user have to be achievable. One service user did confirm they had attended their care review. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 11 Care plans demonstrated where choices have been made. Support staff confirmed service users are always offered choices and this practice was observed during the inspection. Daily notes further demonstrate where choices have been offered and refused. Four service users have communication difficulties and signs and symbols are in place to assist with communication. Staff were observed communicating effectively with all service users at the home during the inspection. Although the inspector was unable to fully obtain the views of all service users on the choices being offered, one-service user did confirm that due to the success of a day care placement, another day had been offered which they chose to accept. There is evidence to demonstrate service users are being enabled to participate in all aspects of life at the home. Examination of records and discussion with staff confirmed one service regularly participates in staff meetings. On the day of the inspection one service user was completing a course on helping to choose staff. The service user did return to the home during the inspection and proudly showed their certificate of achievement. Risk assessments have been completed for each service users and identify the action required to reduce the risk. Staff had signed the assessments to demonstrate their understanding of the measures required to reduce risk. All risk assessments were in need of review. Staff confirmed the manager is currently updating the risk assessments. This was further evidenced through the notes of team meetings. Staff confirmed that once completed they will be required to read and sign the risk assessments. The home has an “unexplained absence” policy and photographs of service users are held on individual files. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 12 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) 12, 13, 15, 16. The home provides service users with a lifestyle that encourages community participation, is age appropriate and suited to their needs. EVIDENCE: There is clear evidence to demonstrate the home is promoting service users involvement in community activities in a non-segregated setting. Work experience has not been explored for service users, as this would not be considered suitable for their needs. The White Horse Care Trust has an equal opportunities policy and this is implemented at the home where the staffing compliment reflects the racial diversity of the local and wider community. There is sufficient staff on duty to enable service users get out and about and discussion with staff confirmed they see this practice as part of the role of support worker. Staff confirmed service users are offered opportunities to go out of the home each day. This practice was reflected on the day of the inspection when service users were out shopping with staff. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 13 Discussion with staff confirmed support is provided to enable service users to maintain contact with family and friends. Service users are encouraged to invite friends to visit the home. Policies and procedures are in place to support service users in maintaining personal relationships. Service users have unrestricted access to all parts of the home. A keypad is fitted to the front door and following a requirement made at the last inspection the use of the keypad is reviewed in relation to service users rights of choice and freedom. A risk assessment has been completed on its use and it concluded the lock was required to ensure the safety of service users. A copy of the assessment was not available for inspection. However one member of staff confirmed this had been completed as part of a risk assessment course they were on. The member of staff confirmed the management team had agreed the assessment. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 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 standard(s) 19, 20. Service users health and personal care needs are being safely met at the home. EVIDENCE: Service users records clearly demonstrate how their health care needs are being met at the home. Care plans contain a summary of health care appointments with GP’s and specialist health care staff such as the diabetic nurse as well as check ups with specialist consultants. Staff confirmed they provide support to enable service users to attend any health care appointments. Service users’ ability to consent or refuse any medical treatment is clearly recorded. One service user has chosen not to consent to a specialist screening programme. Examination of records for the administration of medication demonstrates the home is accurately recording medication received and administered to service users. No service users have been assessed as self-medicating and service users consent to medication is held on individual files. All medication is held securely in the home. Staff confirmed they have received training in the safe administration of medication. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.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) 22, 23. The home does ensure service users are protected from abuse and given opportunity to raise concerns about the service they receive. This good practice should be further extended to include a review of service users paying for meals outside of the home. EVIDENCE: Examination of the complaints book demonstrated the home has not received any complaints since the last inspection. The home has however received a number of compliments from the relatives and supporters of service users, all of which commented on the good standard of care provided at the home. Service users records contain an abridged version of the complaints procedure using symbols and pictures. Service users have also been provided with a stamped addressed postcard that service users can send to the Trust to register any concerns they have with the service they receive. One service user commented they were happy living at the home. Discussion with staff confirmed they have received training in abuse awareness. Staff were very clear about what action they would take to report any concerns regarding the welfare of service users. Local policies and procedures regarding the protection of vulnerable adults were in place at the home. The home was holding money on behalf of service users. Examination of the records of three service users found money held was being accurately recorded. The inspector was concerned to find that the records showed service user were paying for meals outside of the home that would have normally been provided Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 16 at the home. One service user spent a total of £9.18 in nine days for meals taken outside of the home instead of having the meals at home. While it is important to respect service user choice of having meals outside of the home, the practice of service users paying the full cost of the meal with no contribution from the Trust should be reviewed. This is not supported by the service users contract or statement of terms and conditions. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 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 standard(s) 24, 25, 26, 27, 28, 29, 30. The home provides service users with a comfortable, clean, safe and hygienic living environment. EVIDENCE: The home has a relaxed and homely feel and there are photographs of service users on holiday and participating in activities on display. All service users have been provided with a single bedroom. Four bedrooms are on the first floor and one bedroom is located on the ground floor. Service users bedrooms had items of personal possessions and reflected individual taste. One service user said they liked their room and proudly showed off their TV, CD and video collection. There is a separate staff sleep in room. The inspector viewed all areas of the home and found it was clean, comfortably furnished and decorated to a good standard. The only shortfall in the standard of accommodation was the dining room carpet that was stained and clearly showing signs of wear. Discussions with staff confirmed this area is washed and cleaned every week but they do have difficulty removing food that has been ground into the carpet. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 18 It is recommended the carpet be replaced with a more suitable floor covering that can be easily cleaned after each meal. There is a toilet and bathroom on each floor and all doors to toilets and service users bedrooms have been fitted with suitable locks to ensure privacy and safety of service users. The downstairs bathroom is a walk-in shower room specifically installed to meet the needs of the service users following an occupational therapist assessment. The laundry area is sited on the ground floor well away from any food preparation area. The laundry facilities are domestic in style but staff reported they are sufficient for the needs of the home. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.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) 33, 34, 35. A competent and effective staff team is meeting service users needs. EVIDENCE: Examination of the rota demonstrated there are always two members of staff on duty throughout the waking day. In addition, further staff are on duty at peak times and on the day of the inspection three members of staff were on duty. Staff confirmed they felt there was sufficient staff on duty to meet the needs of service users. The rota indicated there was a low turn over of staff and a low incidence of staff sickness. Staff confirmed there are regular meeting held in the home and that service users can participate in the meetings though in reality only one service user chooses to take part. In the absence of the manager staff recruitment records could not be examined and the requirement made at the last inspection will be carried forward. Discussion with the most recently appointed member of staff confirmed they had obtained a satisfactory Criminal Records Bureau check at enhanced level before commencing work. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 20 The member of staff also confirmed they have received induction training and are preparing to commence Learning Disability Award Framework training before completing NVQ level 2 in care. Staff were very satisfied with the level of training provided by the Trust. Discussion with one service user confirmed they were happy living at the home and described the staff as “fine”. The inspector met with five members of staff on duty during the inspection. All staff confirmed they receive supervision almost monthly and that the Trust has implemented annual individual performance appraisals. Staff confirmed that responsibility for supervision is shared between the manager and the deputy. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.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) 42 Overall the home is taking action to ensure the safety, health and welfare of service users. EVIDENCE: Staff training records demonstrate training is being provided in safe working practices including fire safety, first aid and food hygiene. The fire records were examined and highlighted there had been no fire practice since 1/03/05. It is a requirement that a fire practice is held within the next seven days. A health and safety audit is completed in the home each month and an annual audit is completed by an outside agency. The last report was dated 28/10/04. General risk assessments have been completed on the environment. COSHH assessments have been completed and reviewed on the past twelve months. All cleaning products are held securely in the home. Hot water temperatures are checked weekly and temperatures are regulated close to 43c. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 22 Low incidence of accidents to service users would demonstrate staff are aware of the need to ensure service users are kept safe. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.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 x 3 x x 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cherry Orchard (50) Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.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 9 Regulation 13(4)(c ) Requirement The registered person must ensure risk assessments are reviewed a minimum of once a year. The registered person must ensure any additional cost for meals taken outside of the home is clearly recorded in the service user contract, statement of purpose and service user guide. The registered person must ensure evidence is provided at the time of the inspection to demonstrate staff have received a satisfactory Criminal Records Bureau clearance at enhanced level. The registered person must ensure fire drills are held a minimum of every three months. A fire drill must be held by 07/07/05. Timescale for action 01/09/05 2. 23 & 5 17(2) Schedule 4 01/09/05 3. 34 19(5)(6) 01/08/05 4. 42 23(4)(e) 07/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Version 1.30 Page 25 Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc 1. 2. 3. Standard 5 23 24 The registered person should ensure the abridged version of the service users is contract is signed and dated. The registered person should review the practice of service users paying for meals taken outside of the home for meals that would normally be provided in the home. The registered person should consider replacing the dining room carpet. Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.doc Version 1.30 Page 26 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB 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 Cherry Orchard (50) DD51_D01_S3178_50CHERRYORCHARD_V234966_140705_STAGE4.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. 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