Inspection on 24/05/05 for 8 Stickley Lane

This inspection was carried out on 24th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

8 Stickley Lane 09/10/06

8 Stickley Lane 13/01/06

8 Stickley Lane 24/01/05

8 Stickley Lane 11/06/04

8 Stickley Lane 09/02/04

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 8 Stickley Lane Lower Gornal Dudley West Midlands DY3 2JP Lead Inspector Linda Elsaleh Announced 24th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 8 Stickley Lane Version 1.10 Page 3 SERVICE INFORMATION Name of service 8 Stickley Lane Address Lower Gornal, Dudley, West Midlands, DY3 2JP 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) 01902 662076 Langstone Society Mr Clive Lingard Care Home 6 Category(ies) of Learning disability (4), Physical disability registration, with number (2) of places 8 Stickley Lane Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24th January 2005 Brief Description of the Service: Stickley Lane is a purpose built residential home owned by Black Country Housing and operated by the Langstone Society. The home is registered to provide 24-hour care to a maximum of six people with a learning disability including two with additional physical disabilities. Accommodation is provided over two floors; the main staircase accesses the upper floor. On the ground floor are two bedrooms, bathroom with bath chair and walk in shower, lounge, dining room, kitchen and laundry. A further four bedrooms are on the first floor along with the main office, bathroom with shower and toilet, and a further toilet. There are a few parking spaces at the front of the property and a landscaped garden at the rear. The home is situated in a residential area of Lower Gornal and is in keeping with other properties in the area. Local shops and other amenities are within walking distance and a bus service is easily accessible. A private mini bus is also available to service users and the ring and ride can be used if needed. 8 Stickley Lane Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out on 24th May 2005 between the hours of 11:00 and 18:30. The purpose of this inspection was to focus on some of the key standards and report on the home’s progress in addressing requirements made at previous inspections in order to meet the National Minimum Standards for Care Homes for Younger Adults. The inspection process included examination of the information provided on the pre-inspection questionnaire, relevant policies & procedures, records kept at the home, observations of care practices, interviews with senior and support staff on duty and discussions with the registered manager. Short discussions were held with some services users who indicated they were satisfied with the service being provided. A 85 response was received by the Commission for Social Care Inspection to the questionnaires sent to service users’ relatives. All stated they were very happy with the service being provided. Some of the comments included the following statements “the best of care is always provided by the staff” & “my relative calls it home”. What the service does well: What has improved since the last inspection? Since the last inspection a sluice has been installed in the laundry and three staff have attended the Infection Control Protocol Course. Training has also been provided to staff in the safe handling and administration of medication. The home is in the early stages of developing plans to improve the ground floor bedroom and bathroom facilities for service users. 8 Stickley Lane Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 8 Stickley Lane Version 1.10 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 8 Stickley Lane Version 1.10 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) 1 & 5 Service users/representatives are provided with information about the service in a variety of formats to enable them to choose whether the service being provided is suitable to meet their needs and personal preferences. However, the home must provide service users with a revised contract/statement of terms and conditions. EVIDENCE: The home’s Statement of Purpose and Service User Guide is available at the home and copies are available in picture and audio form. The Statement of Purpose has been reviewed within the last 12 months and the Service User’s Guide is currently under review. The inspector was informed a review of the contract/statement of terms and conditions between the home and the service user/their representative, is almost complete and a summary of the key contract terms will be included in the Service User’s Guide. 8 Stickley Lane Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8, 9 & 10 Service users are encouraged to participate in discussions about the development of their care plans to ensure their personal goals and wishes are addressed and, wherever possible, they are supported to take controlled risks. They are encouraged to make their own choices in relation to their daily lifestyles and are able to participate in discussions about the general running of the home and community living through the ‘residents’ meetings. EVIDENCE: The inspector randomly selected three service users’ files to examine. These contained detailed care plans that included, where applicable, the involvement of professionals such as psychologists. Each service user has a key worker who draws up a programme with the service user to assist them to develop their interpersonal and independent skills. Progress is discussed at regular meetings held between with the service user and monitored by the key worker and their allocated care plan co-ordinator. Arrangements are made to formally review the care plan on a regular basis with the service user’s relatives and representatives. The inspector was informed a senior member of staff has completed the Person Centred Planning Facilitator Certified course and is in the process of introducing this into the 8 Stickley Lane Version 1.10 Page 10 home. Where applicable, the home includes strategies for managing unacceptable behaviour. Discussions were held with the manager with regards to ensure strategies for such behaviour is relevant to the situation. Written guidance is to be provided to staff on keeping themselves safe when dealing with unacceptable behaviours and their personal responsibilities. The home undertakes a risk assessment on each service user and, where risks have been identified, details are provided on how these are to managed and/or the action to be taken to minimise the risk. Discussions about risks and risktaking are also held at the regular review meetings. Service users are encouraged to attend ‘residents meetings’ and express their views and opinions on the running of the home. An agenda is drawn up with the service users prior to the meeting and appropriate minutes are kept. Records show that the service users are consulted on their daily preferences, such as meals and activities. The home’s Statement of Purpose includes information with regards to confidentiality. The home’s policy on respecting confidentiality is discussed with newly appointed staff as part of their induction process and when undertaking the National Vocational Qualification (NVQ) training. The senior member of staff on duty is responsible for ensuring service users records are held secure. 8 Stickley Lane Version 1.10 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 The home offers service users a healthy and varied selection of meals to meet their personal preferences and cultural and dietary needs. Service users are encouraged to view mealtimes as social occasions, but may eat alone if they choose. EVIDENCE: The records show that service users are consulted on a daily basis with regards to meals and mealtimes and, depending on their ability, are encouraged to participate in the preparation of meals and associated tasks. Nutritional assessments have been completed on all service users and, at present, none have been identified with any specific dietary needs. However, staff record and monitor individual’s dietary intake, weight and disposition to ensure they are receiving a healthy and balanced diet. Where any concerns are raised, the relevant specialist is contacted for advice. In general, service users are encouraged to view mealtimes as a social occasion, however, arrangements are made for service users, who wish to dine alone. The inspector was informed each member of staff has obtained a Basic Food Hygiene Certificate that is up dated every three years. 8 Stickley Lane Version 1.10 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 The home provides service users with personal support in the way they prefer and with respect for their privacy and dignity. Medication is managed in accordance with the home’s policies and procedures by designated staff. An external pharmacist provides training in the safe handling of medication and regularly reviews the home’s records and practice. EVIDENCE: Each service user has a key worker who discusses with them how they wish to be supported in the delivery of their care plan. All personal care is carried out in private and in a manner that respects the service user’s dignity. Arrangements are made for all service users to receive regular health care check ups. The home has good systems for identifying and monitoring any medical needs. A record is kept of discussions held with service users with regards to their health care and of any appointments that a service user has declined to attend. The home has written procedures for the safe handling and administration of medication. The senior staff team were identified as holding responsibility for managing service users’ medication. Arrangements are made for the safe storage of medication and appropriate entries are made on the medication administration record sheets (MARS). None of the current service users are managing their own medication. An independent pharmacist visits regularly to 8 Stickley Lane Version 1.10 Page 13 review the home’s records and practice and has recently provided training to staff in the safe handling and administration of medication. 8 Stickley Lane Version 1.10 Page 14 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 Service users are encouraged to express their views, on an individual and group basis, about the service. The home takes positive steps of act on the comments is receives. Service users and their relatives/representatives are provided with information on how to make a complaint, however, written guidance needs to be provided for staff on receiving and recording complaints. The home has appropriate procedures for ensuring service users are protected from abuse, neglect and self-harm, with the exception to its whistle blowing policy, which is being revised. Staff receive training in adult protection issues. EVIDENCE: The inspector was informed no complaints had been received by the home, or its organisation. There have been no complaints received by Commission for Social Care Inspection. The home has a policy on how service users and/or their relatives/representatives can make a complaint. This is produced in written and picture formats. As previously stated, the home has good systems for consulting with service users; which provides them with different opportunities and settings in which they may raise any complaints or concerns directly with staff. The inspector was informed relatives/representatives are asked if they have any concerns or complaints about the service at the service user’s annual review. Staff informed the inspector how they would individually handle a complaint made to them by a service user or relative. The inspector was informed that there is no guidance or formal system for handling or recording complaints. Therefore, written guidance needs to be produced for staff in receiving 8 Stickley Lane Version 1.10 Page 15 complaints and an appropriate system identified for recording the nature of the complaint, the investigation carried out, action taken and outcome. A ‘free-post’ postcard is made available to service users to inform the home’s head office they wish to make a complaint directly to them. A representative of the organisation makes contact with the complainant to arrange to discuss his/her concerns. This method of communication needs to be revised in order to maintain confidentiality and to protect service users right to privacy. A copy of the local authority’s adult protection procedures is available for staff and the home has its own adult protection and whistle blowing policy. The whistle blowing policy is in the process of being revised to include a clear statement informing staff that they may contact the Commission for Social Care Inspection (CSCI) at any time. The staff demonstrated that they are familiar with the Department of Health’s Guidance - No Secrets and a copy is available in the home. 8 Stickley Lane Version 1.10 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 The infection control practiced in the home ensures service users are protected against cross infection. However, the home’s procedure must be revised to incorporate the use of the newly installed sluice. EVIDENCE: The inspector was informed that the home follows Dudley Local Authority’s procedures on Infection Control. Since the last inspection a sluice has been fitted and the home needs to revise its own procedures with regards to handling soiled linen to incorporate its use. Three staff have attended the Infection Control Protocol Course and are responsible for undertaking and recording infection control risk assessments. Staff are responsible for carrying out laundry tasks; such as washing and ironing. However, where possible, service users are encouraged to take their washing to and from the laundry room as part of developing their independent living skills. During the refurbishment of the kitchen appropriate catering arrangements were made for the service users. 8 Stickley Lane Version 1.10 Page 17 The manager discussed with the inspector the home’s future plans to improve bedroom and bathroom facilities for service users on the ground floor. These plans are in the early stages of development and details will be formally submitted to the Commission for Social Care Inspection (CSCI) at a later date. 8 Stickley Lane Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 & 36 The staff team brings with them a variety of skills and experiences and have clearly defined roles and responsibilities that enables a high standard of care to be provided to all service users. The home provides supervision and training for staff in health & safety and client-centred issues to ensure the needs of the service users are being appropriately met. EVIDENCE: The staff team complement consists of a manager, deputy, senior and support staff. There has been no new staff appointed since the last inspection and the home does not use the services of volunteers. The inspector was informed that appropriate arrangements are in place for the induction and training of newly appointed staff. 87 of the staff team have achieved the National Vocational Qualification (NVQ) Level 2. Staff who spoke with the inspector demonstrated that they had a clear understanding of their roles and responsibilities and that of other team members. Staff stated that their job descriptions are linked to meeting service users’ individual care plans. 8 Stickley Lane Version 1.10 Page 19 The inspector observed staff communicating effectively with individual service users and demonstrated their awareness of service users’ individual needs and how these were being met through their interactions, the records kept and their discussions with the inspector. Specialists, such as therapists and psychologists, are consulted whenever necessary and detailed records are kept of this contact. Examination of the rotas showed appropriate staffing levels are maintained and, where necessary, these are increased to meet the changing needs of the service users. There is a mixed range of skills and experience within the staff team. The service users are of mixed gender and discussions were held with the manager with regards to a predominately single gender staff team. The manager informed the inspector of the difficulties experienced in recruiting and retaining male staff. However, the situation is monitored on a regular basis and where the need for additional male role models are identified an appropriate course of action is discussed with the service user’s relative/representative and the organisation. Staff meetings are held on monthly basis and include planned discussions of each service user’s care plan, policies, procedures and practices. Minutes are kept of each meeting and all staff sign to state they have read and understood these. The inspector examined a random selection of staff records with regards to training, development and supervision. Details are kept of the mandatory training that has been undertaken in various health and safety and specific client-centred issues. The record is kept of the dates when this training needs to be updated. The home has an identified training officer within its staff team, who is responsible for ensuring appropriate training programmes are developed to meet the learning and training needs identified in individual workers annual appraisals and team training. The service user’s key worker meets with the identified key worker coordinator every 3 to 4 weeks to discuss the service user’s progress and to identify and address any areas of concern. Individual supervision is provided approximately every 6 to 8 weeks. The agenda is agreed between the supervisor and supervisee from their work plans. A written record of these meetings are agreed and signed by both parties. The manager is advised to monitor these sessions to ensure they include all the issues detailed in Standard 36.4 of the National Minimum Standards for Care Homes for Younger Adults on a regular basis. 8 Stickley Lane Version 1.10 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 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) 38, 40, 41 & 42 The manager has demonstrated effective leadership and management skills in the running of this home. He ensures service users receive a high standard of care through the implementation of good health and safety procedures and practices. EVIDENCE: Throughout the inspection the manager demonstrated a positive approach to creating an open and inclusive atmosphere. Staff are enabled to develop their knowledge and skills through being allocated individual areas of responsibility and service users are provided with different settings to encourage them to openly express their opinions and views about the service. The files kept by the home were appropriately constructed and records were up to date and in good order. All information held on service users and relevant records pertaining to the home are stored appropriately and in accordance with current data protection legislation. However, as previously stated in this report, a system needs to be developed for the recording of any complaints the home may receive. 8 Stickley Lane Version 1.10 Page 21 In the main, the home has appropriate written policies and procedures that comply with current legislation and recognised professional standards. The manager monitors safe practice within the home, in accordance with its policies and procedures, and provides appropriate training and staff sign and date each of the home’s policies and procedure to indicate they have read and understood them. As previously stated in this report, the inspector discussed with the manager the need to revise the home’s whistle blowing and infection control procedures and provide written guidance for staff in keeping themselves safe when managing unacceptable behaviour. The records show appropriate systems are in place for the regular inspection and service of the home’s equipment and the premises. 8 Stickley Lane Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x x x 2 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x 2 Standard No 11 12 13 14 15 16 17 x x x x x x 4 Standard No 31 32 33 34 35 36 Score 3 3 4 x 4 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x 2 2 3 x 8 Stickley Lane Version 1.10 Page 23 Yes 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 5 Regulation 5 Requirement Develop a contract covering all the requirements under this standard and 16.11 in a suitable format. (Original timescale of 01.04.05 not met) The whistle blowing policy must clearly state that staff may contact the CSCI at any time without facing disciplinary action. (Origninal timescale of 01.04.05 not met) All staff must have a recent photograph. (Not assessed) Timescale for action 13th September 2005 13th September 2005 2. 23 12, 22 3. 34 19 4. 35 18 An induction and foundation policy and procedures to be implemented. (Not assessed) 5. 39 24 The home must maintain an effective quality assurance and monitoring system. (Not assessed) 1st May 2005 To be reported on at the next inspection 1st May 2005. To be reported on at the next inspection 1st May 2005 To be reported on at the next Page 24 8 Stickley Lane Version 1.10 inspection 6. 6 12 The registered manager must ensure strategies for managing unacceptable behaviour are relevant to the situation and staff are provided with written guidance on keeping themselves staff and their responsibilities when managing such behaviour. The registered manage must provide written guidance for staff in receiving complaints and a system for recording complaints appropriately. The responsible person must revise its method for enabling service users to contact the organisation about complaints. The registered manager must revise the homes infection control procedures to include the use of the sluice. 13th September 2005 7. 22 22 13th September 2005 13th September 2005 13th September 2005 8. 22 22 9. 30 23 10. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 25 Good Practice Recommendations It is recommended that should the ground floor room below the minimum standard of 12sq metres become vacant it should not be used for a service user who uses a wheelchair or has complex medical needs. Consideration should be given to locating more storage space for wheelchairs and hoists. The inspector recommends the registered manager monitors individual supervision agendas to ensure all the issues detailed in this standard are discussed on a regular basis. 2. 3. 25 36 8 Stickley Lane Version 1.10 Page 25 Commission for Social Care Inspection Mucklow Office Park, West Point Mucklow Hill Halesowen West Midlands B62 8DA 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 8 Stickley Lane Version 1.10 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!