Inspection on 06/11/07 for 62 Cheltenham Road

This inspection was carried out on 6th November 2007.

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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

62 Cheltenham Road 06/11/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 62 Cheltenham Road Evesham Worcester WR11 2LQ Lead Inspector Sue Davies Unannounced Inspection 6th November 2007 18:30 62 Cheltenham Road DS0000069559.V342449.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 62 Cheltenham Road DS0000069559.V342449.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. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 62 Cheltenham Road Address Evesham Worcester WR11 2LQ 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) 01386 442 783 Noble Care Ltd Mr Martin William Crookston Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes between the ages of 18 and 65 years whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 3 The maximum number of service users to be accommodated is 3. 2. Date of last inspection 31st August 2006 Brief Description of the Service: 62 Cheltenham Road is residential care home in Evesham, which provides specialist support for up to three people with a learning disability. It has been newly registered to a new provider in May 2007. The house is a semi-detached property, which offers single bedroom accommodation. It is close to Evesham town centre as well as the park, Abbey and river Avon. Limited parking is available upon the drive. The registered provider is Noble Care Limited. The registered manager is Mr Martyn Crookstone who also manages another care home owned by the same provider in Evesham. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was made to carry out a statutory key inspection. The focus of this first inspection since the new registration was to monitor the management and service provision at the home. Preparation for the inspection included information about the home’s recent history, the AQAA , contact information and monthly visit reports completed by the provider. The inspection was undertaken over early to mid evening on the day of inspection. Time was spent talking with the member of staff and all 3 service users, who all indicated they were happy to be living and working at 62 Cheltenham Road. The care records of 2 service users were seen, and delivery of care and support was discussed with the staff member. Records kept in respect of staffing, medication, food provision and a sample of the home’s written policies and procedures were also checked. The time and assistance everyone made available for the inspection were appreciated. What the service does well: Service users with various difficulties have good help from staff to live together in a small family style home and have more responsibility and control over their own lives. They receive individual support from staff who understand them well, make the most of training and are very keen to help them make the best use of opportunities to build their life skills and confidence. The home is a well equipped and comfortable place to live, and staff are supporting service users to make the home their own. Staff and service users treat each other with friendly consideration and respect, and daily routines reflect the service users chosen lifestyles. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: It would be better for this service to have its own registered manager but two services still share one manager. This needs to be looked at to make sure there is enough time and attention for developing this service in the way service users need. Talking to staff shows good checks are made before staff are employed, to make sure service users are supported by staff they can trust. Careful records need to be kept and available for inspection to show this. A full quality assurance system needs to be set up so service users have a real voice in how their service develops. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 7 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. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 8 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 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. While there is no current vacancy the service is well prepared should one arise, to help future service users make the right decision about whether the home would be right for them. EVIDENCE: The current service users are settled and any change in the resident group is unlikely for now. However should this happen, there is a good approach to admitting new people with a chance for the new service user and staff to meet first and get to understand each other well. There are opportunities for a visit, meeting other service users and staff, and staying overnight in the home, to help prospective service users, their carers and supporters in reaching decisions about moving in to the home. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Good progress is being made in developing person centred plans and towards supporting service users to take a fuller role in directing their own lives. EVIDENCE: There has been good progress here. Service users were happy for the inspector to look at their plans. The information is clear and easy to read, with pictures and photographs supporting the words, clearly showing how the service works from the service users point of view. This style is being adopted more throughout the service user plan and other records and information such as health care information. Staff have received training in person centred planning and it is easy to see how service users are now working with staff on putting together their Essential Lifestyle Plans. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 11 It was clear during the inspection that staff and service users treat each other with friendly consideration and respect, and daily routines match service users chosen lifestyles. Service users explained how all share in taking care of their home through routine chores and contributing to decisions about the way some things are done, for example recent redecoration and refurbishment. Service users are getting more involved in wider issues about the way the service is developing, for example taking part in staff recruitment and future planning. The quality assurance system could be used better to build on this. Everyone helps with planning, shopping and cooking meals, with a general focus on healthy eating. Information on a notice board in the kitchen shows daily activities in and outside the home and daily responsibilities. This information could be more detailed and use pictures and symbols, so that everyone in the home can use it however they communicate. Although staff have had some training in communication it would be good practice to explore total communication training for all staff. This would help make sure everyone is included so information is shared properly. Service users are getting good support to help them understand and manage risky situations in their day to day lives, which is helping them develop personal responsibility and independence. Records about risk assessments and strategies for managing them show staff talk these through carefully with service users, and that they are relevant and appropriate. For example service users are being effectively supported towards independence in voluntary work placements, and if any problems arise these are talked through with the service user and new strategies agreed to manage the difficulty and restore independence. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have been enjoying making this home their own and getting to know the area they live in better, and are being helped by staff to move forward at their own pace. EVIDENCE: All three service users were in the home at the time of inspection. Information about this service users lifestyles was clearly recorded in their service user plans. One service user pointed out that although his week’s planning and daily activities were on the kitchen notice board he needed staff to help him understand this. He explained he cannot read but he can understand pictures and symbols. Training for staff in such communication techniques would therefore be appropriate. Service users were happy with their present lifestyle, enjoying going out and doing new things with staff support and encouragement but also enjoying pursuits at home. Service users told how they are supported to keep in touch 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 13 with family, and to develop important relationships in the community. For example, one service user explained how much he enjoyed a church fellowship group. There are also close links with friends among service users living at the sister house. Discussion with service users and the staff member, and information from service user plans showed that they all attend college and/or day centres, and are well supported to follow many leisure activities in the local and wider community according to personal interest. Examples include church, volunteering in charity shops, sports activities, fruit picking, music concerts, going out to pubs and restaurants. Everyone joins in meals planning, shopping and food preparation. Simple menus provide a basic record of food eaten. Records about each meal show generally balanced meals with attention to healthy eating. Staffing levels provide the basic support service users need, while staff explained that they are willing and able to work flexibly and do extra hours as needed. However there was only one staff on duty on the evening inspected, all service users were at home and got ready for bed quite early. If this is typical, evening staffing levels could be too low. It is important perceptions about staffing levels do not lead service users to limit their own expectations, and staffing could be varied to encourage more outside activities later in the day. All service users feel that they have enough interesting things to do at present, with the opportunity to meet people and make friends but it is important that they also have the chance to think about what they might achieve in future. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Good progress has been made and staff have received training to promote a person centred approach, this is now being implemented so that service users have a more central role in managing their own health care. EVIDENCE: Staff have been trained in person centred planning to shift practice towards service users being at the heart of the process. Essential Lifestyle Plans have now been established. Service users spoken to felt staff understood them well, and this was confirmed in speaking to the staff member on duty. Although new to the service she spoke knowledgeably and confidently about service users, including recent concerns and how these were responded to. Service users’ individuality is clearly valued, with personal responsibility and independence promoted. Service users are generally able to attend to most personal care matters themselves with some prompting support. Their Essential Lifestyle Plans are clearly written in discussion with them with them reflecting their individuality, preferences and expectations relating to daily routines and any support given. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 15 Health Action Plans have now been completed updating and coordinating health care information, placing the service user at the centre of managing their own health care. Health information in service user plans shows good evidence of health care intervention and treatment. These records could now be developed further consistent with a person centred approach towards monitoring health and promoting good health care practice consistent with individual age and health profiles. Each service user has an individual medication profile, although two service users need little medication. It is good practice to identify service users’ medication administration records by photo as well as by name. Procedures in place for the management, storage, administration and recording of medication, including homely remedies, are generally sound. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff are committed to service users’ well being and service users are confident they can speak to staff or management if they have any concerns, but a more robust and consistent approach is needed in the overall management of procedures to safeguard service users, and in the provision of suitable training to guide and support staff. EVIDENCE: There have been no complaints about any aspect of the service since the previous inspection. Service users were clear they could speak to staff, the manager or the provider if they had any concerns. They said they were happy with their home, lifestyle and the help staff gave them. During the course of inspection staff related to service users with respect, warmth and understanding, and showed dedication and willingness to give their own time to support service users if they thought this was needed. Staff spoken to had specific training and a good understanding of adult protection and the action they should take if abuse were suspected, and written procedures are in place. Information provided shows staff have had training in relevant areas such as risk management and management of behaviour which may challenge them. Care should be taken to ensure written guidance incorporates up to date information about local procedures for responding to suspicion of abuse. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 17 The staff member spoken to was able to confirm sound recruitment procedures were followed prior to her appointment. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is a well equipped and comfortable place to live, and staff are supporting service users to make the home their own place. EVIDENCE: The accommodation is homelike, with pleasing décor and comfortable furnishings in good order. Service users explained how they all share responsibility with staff for looking after their home, taking care of their own rooms themselves with help and encouragement if they need it and with a rota so that they know their own chores. Their home is cared-for and comfortable with a lived-in atmosphere, where the staff are supporting them to live in the way they choose. One service users bedroom and sitting room seen were furnished and decorated to reflect personal tastes and interests, and all service users said 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 19 they were happy with their rooms and the accommodation generally. Communal areas are spacious, equipped with things to do such as television, DVD and music systems, puzzles and games, and comfortably furnished. There is a garden with comfortable seating and equipment such as a barbeque. Redecoration and refurbishment had been completed and service users had been involved in planning the improvements, and the home was being maintained to a good clean and fresh standard. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 20 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 and 34 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have confidence in the staff to support them as they need and wish. However some care may be needed to make sure staffing levels allow service users the individual support they need including to follow personal activities outside the home in the evening should they so wish. There is commendable support and encouragement for staff training and development, underpinned by foundation training in learning disability focussed care practice and mandatory skills. EVIDENCE: Observation and discussion at the time of the visit showed service users benefit from the support of a stable group of staff they are getting to know well. The staff met in the course of the inspection was highly committed and professional in her approach, and talked about the support and encouragement she received from the deputy and staff team to improve her knowledge and skills about service users needs, and the programme of staff training. Service users confirmed are confident staff understand them and can give them the help they need and want. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 21 All staff are encouraged to attain National Vocational Qualification level 3 and have either achieved or are working towards this, with foundation training linked to Learning Disability Advisory Forum standards. The deputy is skilled and supports the manager ably. Confirmation has been sent by the providers that she has recently obtained her National Vocational Qualification level 4 in management of care, and the Registered Managers Award. Service users do need to be confident that enough staff are employed who are skilled and deployed effectively, so that they know they can be supported to live their lives in the way they choose. Rota information about staff deployment needs to be recorded fully, and made available to service users more clearly so that it is easy for them as well as anyone else to understand the arrangements, and this could be achieved with the details of staff on duty clearly displayed on their notice board in a suitable format everyone can use readily. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 22 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, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although the manager has able support from a deputy, development of this service has been limited by the division of management time between two homes. To enable it to progress and ensure service users can take their full part in its development, a full time manager is needed whose time is dedicated to this service. EVIDENCE: There is reassuring evidence that service users are able to benefit from staff who are highly motivated, encouraged to progress in training and committed to the help and support they provide for them, and feel well supported by the deputy. There is a generally improving approach to ensuring the safety and well being of both service users and staff, and most staff have now completed safe working practice training. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 23 However, this report shows evidence that with the manager’s time divided over two services, the level of management input, direction and oversight is still less than needed for a developing service. Thus although the prospects are promising there is still work to be done to establish the sound foundations for future service development, so that service users can be confident this will progress in the right direction to support their own personal development effectively. The provider makes regular monthly visits to check on the conduct of the home and providing a report on this. Discussions have taken place regarding the need to have a manager specifically registered and responsible for this service, and it is hoped that a registration application will soon be made to the Commission for consideration. No report is yet available showing an effective quality assurance system in place as required by regulation, so service users have not yet had the opportunity to comment formally on their opinions of the service and see these responded to in an action plan. Seeking and responding to the views of the people who use the service, and providing them with the support and resources they need to play an effective part in how the service works and develops, should be integral to its future development. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 24 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 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 X 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 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 x 2 x 1 x x 3 x 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 25 N/A 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 YA39 Regulation 24 Requirement A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 39, which include the provision of a report to the Commission. A proposed system has been submitted to the Commission for consideration and feedback has been provided. This requirement has therefore been partially met and is therefore repeated Timescale for action 08/03/08 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 YA35 YA37 Good Practice Recommendations Staff records should be in place and available for inspection to show satisfactory staffing arrangements including sound recruitment practices are in place Consideration should be given to appointing a full time manager at 62 Cheltenham Road to ensure the DS0000069559.V342449.R01.S.doc Version 5.2 Page 26 62 Cheltenham Road management responsibilities for this service can be fully met and full attention given to service development. 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 62 Cheltenham Road DS0000069559.V342449.R01.S.doc Version 5.2 Page 28 - 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!