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Inspection on 01/02/06 for 8 Trescott Road

Also see our care home review for 8 Trescott Road for more information

This inspection was carried out on 1st February 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users said that they like the staff and their key worker. They said, "The staff look after for me and make me happy." The ex by ex said: " The service users seemed well cared for." Service users bedrooms contain many personal items and they choose the decoration of their bedroom. Staff listen to what service users say and help them to complain if they are not getting the service from other agencies they need to be as independent as possible. Service users choose where they go on holiday and where they go out. The ex by ex said: "I understood the complaints and fire procedures up on the wall." The conservatory is a relaxing place for service users to spend their time. The health and safety of service users and staff is considered to be important. Regular checks on equipment are done to make sure they are working.

What has improved since the last inspection?

The medication administration records were all signed for as staff had given the medication to service users. The storage and giving out of medication was good and has improved. A Deputy Manager has started working there and has helped to manage the home and lead staff.

What the care home could do better:

All service users must have regular checks at the dentist. Staff must receive training in the prevention of abuse so that they know how to keep service users safe from harm. New chairs must be bought for the lounge so that service users can be more comfortable. Permanent night staff must be employed to work at the home. A manager must be employed so that they can lead staff to meet the needs of individual service users.

CARE HOME ADULTS 18-65 Trescott Road (8) Northfield Birmingham West Midlands B31 5QA Lead Inspector Sarah Bennett Unannounced Inspection 1st February 2006 13:00 Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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 Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Trescott Road (8) Address Northfield Birmingham West Midlands B31 5QA 0121 475 9585 0121 475 9585 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) Trident Housing Association Care Home 7 Category(ies) of Learning disability (7), Physical disability (7) registration, with number of places Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents must be aged under 65 years, with a learning disability, which may also include associated physical disabilities. Laura Thomas should complete the Registered Managers Award (Adult) N.V.Q. Level 4 by March 2005 22nd September 2005 Date of last inspection Brief Description of the Service: 8 Trescott Road is registered for seven people who have a learning disability and additional physical disabilities. It is a purpose built residential home. The layout and design offers an accessible and spacious facility. The home is equipped with en suite facilities for all seven bedrooms. A stair lift provides access to two bedrooms, office and staff sleep-in facilities on the first floor. It is unfortunate that in a purpose built home for people who have a physical disability all areas of the home cannot be accessed by people who use a wheelchair. Five of the service users cannot access the first floor. Ground floor accommodation includes five en suite bedrooms and an open plan dining room/lounge and a conservatory. The kitchen is accessed off the dining area. To the rear of the home there is an enclosed garden, there is scope to develop the garden so that it could be utilised more by the current service users. To the front of the home there is off street parking for a number of cars. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out in one afternoon. Service users, the Deputy Manager and the staff on duty were spoken to. Not all service users spoken with were able to give a view of the home due to their communication needs. A partial tour of the premises took place. Care, staff and health and safety records were looked at. This was the second of the statutory inspections for this home for 2005/2006 and not all of the National Minimum Standards were assessed. To get a full picture of the home it is advised to read this report in conjunction with the report from September 2005. Margaret Wyre (expert by experience) and her supporter from ‘Sandwell People First’ were there for part of the inspection. As a service user Margaret has an expert opinion on what it is like to receive services for people who have a learning disability. As part of the Inspection Team, Margaret’s comments are included throughout this report. What the service does well: Service users said that they like the staff and their key worker. They said, “The staff look after for me and make me happy.” The ex by ex said: “ The service users seemed well cared for.” Service users bedrooms contain many personal items and they choose the decoration of their bedroom. Staff listen to what service users say and help them to complain if they are not getting the service from other agencies they need to be as independent as possible. Service users choose where they go on holiday and where they go out. The ex by ex said: “I understood the complaints and fire procedures up on the wall.” The conservatory is a relaxing place for service users to spend their time. The health and safety of service users and staff is considered to be important. Regular checks on equipment are done to make sure they are working. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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 the following standard(s): 5 Service users have a contract so that they know the terms and conditions of their stay at the home. EVIDENCE: Service users records included a contract that detailed the terms and conditions of their stay at the home. They also included a Licence Agreement. The contract or the Licence Agreement were not signed and dated by the service user or their representative and the registered manager. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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 the following standard(s): 6, 8, 9 Service users assessed needs and goals are reflected in their care plan so that staff know how to support each individual. Service users are consulted on all aspects of life in the home. Service users are supported to take risks within a risk assessment framework. EVIDENCE: Each service user had a care plan. Staff told the Inspection Team that care plans are being updated. The service user and their key worker regularly review their care plans. Care plans included service users short and long term goals and how staff are to support them to achieve these. At the last inspection one of the service users was writing their essential life book with the support of their key worker but the Inspection Team did not see a copy of this in the service users bedroom. Staff and service users told the Inspection Team that the tenant participation officer who works for Trident was coming in the evening to facilitate the service users meeting. The ex by ex said, “ I think that this is good because the service users need someone other than the staff to speak openly to”. Service users told the Inspection Team that they were going to talk about holidays at Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 10 the meeting. Two service users said that they went to Majorca on holiday last year and would like to go again this year. Service users records sampled included a risk management plan. These were detailed and included all the risks to the individual and how staff are to support them to minimise the risks. All the risk assessments had been recently reviewed and updated where necessary. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14, 16, 17 Adequate arrangements are in place so that people living in the home experience a meaningful lifestyle. EVIDENCE: Most of the service users go to day centres and one service user goes to college. One service user has chosen to stay at home during the day and funding has been agreed for this. One service user said, “ Sometimes I go to the pictures, the pub, café and the hairdressers.” Service users said they go out in the minibus or by taxi. Service users records sampled stated that they go to pubs, restaurants, pantomimes, shopping, to college, day centres and to the bank. Inside the home service users watch TV and DVD’s, do jigsaws and play games. One service user has their own computer, which they said they often use. Several games and arts and crafts materials are provided. Service users told the Inspection Team that they get up and go to bed when they want to. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 12 Service users records showed that they tidy their bedroom, wash up and make their own breakfast as much as they are able to. Service users were observed taking their plate to the kitchen after lunch to wash it up. Staff and service users told the Inspection Team that every Friday a menu is planned with the service users. Service users said that they go shopping with the staff and choose what they eat. The ex by ex said, “ I thought it was good that the service users knew what was for tea as often they do not get told.” The fridge was well stocked and plenty of fresh fruit, vegetables and salad were available. Menus were varied and special diets catered for. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Generally arrangements are adequate to ensure that service users receive appropriate personal support and their health needs are met. Adequate arrangements are in place to ensure that the management of the medication protects service users. EVIDENCE: Service users records included a manual handling assessment that was detailed, regularly reviewed and updated where necessary. As service users came home from the day centres staff made them each a drink and where appropriate supported them to drink it. Service users were well dressed appropriately to their age, the weather and the activity they were doing. One service user was in hospital following some epileptic seizures. Staff said that a member of staff visits the service user each evening. Where appropriate health professionals are involved in the care of service users. These include the Psychiatrist, Community Nurse, Speech and Language Therapist and Physiotherapist. Service users records sampled stated that they regularly went to the opticians for an eye test. The service user visited the dentist in February 2005 and the record stated that they would need another check up in six months. However, Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 14 there was no record that they went for this check up. The Deputy Manager said they would check this. Health Action Plans have been developed for individuals. These are personal plans about what a person can do to stay healthy. These were detailed and produced in a format that service users can understand. Boots supply the medication to the home in blister packs using the monitored dosage system. Medication Administration Records were signed appropriately by staff and cross-referenced to the blister packs indicating that medication had been given as prescribed. Medication is stored in a locked cabinet. This was clean and well organised. One service user was prescribed a Controlled Drug (CD). This was stored separately and staff recorded in the CD register when it was given. The CD register cross-referenced with the amount stored in the CD cabinet. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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 the following standard(s): 22, 23 The arrangements for making complaints ensure that service users views are listened to and acted on. Arrangements are not adequate to ensure that service users are always protected from abuse. EVIDENCE: The Inspection Team saw an easy to understand complaints form on the wall. The ex by ex said: “I can’t read words and I understood the forms by looking at the pictures. I thought this was good”. One service user came home from the day centre upset as their wheelchair was not working properly and this was the fourth time recently that this had happened. The service user was not able to move their wheelchair from side to side so they were not able to mobilise independently. Staff took time to talk to them and reassure them that an engineer would be coming the next morning to repair it. Staff told the service user that if it was not repaired properly this time they would support them to make a complaint and the service user agreed to this. The CSCI have received no complaints about the home. The Deputy Manager said that a complaint had been received from a neighbour about noise levels. This has been investigated and resolved. The Deputy Manager said that headphones are provided so that service users can listen to music without disturbing others. Service users told the Inspection Team that they have their own money and choose what they spend it on. Service users records included an inventory of their belongings. These were detailed and regularly updated. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 16 Staff have not received training in adult protection and the prevention of abuse. This remains outstanding from the last inspection. The Deputy Manager said that staff are booked to do this in the next three months. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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 the following standard(s): 24, 26, 28, 29, 30 Arrangements are generally adequate to ensure that people live in a homely, comfortable, clean and safe environment. EVIDENCE: The ex by ex said: “I liked the conservatory. There are lots of mobiles hanging down for the residents to look at”. One service user chose to sit in the conservatory to watch TV. Staff said that they hope to get some sensory equipment from another home to use in the conservatory. The frames of the sofas and chairs in the lounge were worn. Staff said and service users were observed having difficulty getting up from the sofa. Staff said they were planning to replace the small table in the lounge. One of the service users was looking through a catalogue to choose this. Service users told the Inspection Team that they chose how they wanted their rooms decorated. Service users bedrooms seen were personalised. The Inspection Team saw that service users were helped on and off the stair lift appropriately. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 18 The home was clean and free from offensive odours. The home was warm despite it being a very cold day. The fire was on in the lounge to supplement the heating. There was a fireguard fitted to the fire. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35 The arrangements for staffing the home and their development was variable and needs to be addressed so that service users needs are always adequately met. EVIDENCE: The Deputy Manager has NVQ level 2 and 3. Three members of staff have NVQ Level 2 and two members of staff are in the process of completing it. The standard requires that 50 of staff achieved NVQ level 2 by 2005, which the home has met. The Inspection Team thought that staff seemed to communicate well with the service users. There is a part-time post vacant for day staff. There are two waking night staff posts vacant. These are covered by agency staff that have worked at the home for a number of years. The Deputy Manager said that the organisation is planning to make temporary contracts permanent. Rotas showed that one member of staff was on Maternity Leave and one member off staff had phoned in sick that day. Bank staff that work at the home regularly and know the service users well covered their shifts. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 20 Staff have not received training in adult protection and the prevention of abuse. This remains outstanding from the last inspection. The Deputy Manager said that staff are booked to do this in the next three months. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Adequate management arrangements are in place to ensure that service users benefit from a well run home. The continued absence of a Manager may affect this. Generally adequate arrangements are in place to ensure that service users views underpin all self-monitoring by the home. Adequate arrangements are not in place to ensure that the homes record keeping practices always uphold service users rights. Adequate arrangements are in place to ensure that the health, safety and welfare of service users is promoted and protected. EVIDENCE: The Registered Manager was promoted within the organisation just before the last inspection. The Manager post is still vacant. Since December 2005 there has been a Deputy Manager in post. They are undertaking the role of Manager and the Deputy Manager. This is not acceptable and means that they have Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 22 little time to be a ‘role model’ for support staff in working with the service users. A quality assurance system is in place that looks at the quality of care, staff, the environment and management and the organisation. This had been completed however; it was not dated or signed so it was not clear who had completed it and when. The system is detailed and the Deputy Manager said that it is going to continue to be used within the home and the organisation. A Manager from the organisation visits the home monthly and a report of their visit is sent to the CSCI. These reports are detailed and consider the views of service users and where possible their representatives. Health and safety records were well maintained and up to date. Service users records were kept up to date. Some service users records sampled were not descriptive about service users behaviour. One record sampled said, “ Has been very demanding today.” There was no further detail about how the service user was demanding or how they were supported. The Deputy Manager said that they are looking at how they can improve record keeping through supervision and staff meetings. Staff take the temperature of the fridge and freezer daily and these were recorded as within safe food storage limits. Fire records showed that staff test the fire alarm weekly and emergency lighting monthly to make sure they are working. The last fire drill was in May 2005 however staff said that there would be one later that afternoon as it was in the diary. The Inspection Team were there for the fire drill and saw that everyone was brought out in a calm way, which was good. Staff test the water temperatures weekly and these range from 40 – 42 degrees centigrade. The recommended safe limit to make sure that the water is not too hot or cold is 43 degrees centigrade. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 1 X 2 X 2 3 X Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? Yes 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. 2. 3. 4. 5. Standard YA19 YA24 YA35YA23 YA33 YA37 Regulation 12 (1)(a) Requirement Timescale for action 28/02/06 30/09/06 31/05/06 31/03/06 31/03/06 Service users must have regular dental check ups and a record of these must be kept. 23(2)(b,c) New sofas/ chairs must be provided in the lounge. 13(6) All staff must receive training in 18(1)(c) the prevention of abuse. Previous timescale not met. 18(1)(a,b) Vacant night support worker posts must be appointed to. Previous timescales not met. 8(1)(a) The Manager post must be 2(a,b) recruited to. The CSCI must be informed when a manager is appointed. Previous timescale not met. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA5 YA6 YA39 YA41 Good Practice Recommendations The contract should be signed and dated by the service user or their representative and the registered manager. The service users should have an accessible copy of their care plan. The quality assurance system should be dated and signed by the person completing it. Service users records should clearly describe their behaviour and be non-judgemental. Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Trescott Road (8) DS0000016936.V282161.R01.S.doc Version 5.1 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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