Inspection on 20/12/06 for 83 Burgh Road

This inspection was carried out on 20th December 2006.

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

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

Other inspections for this house

83 Burgh Road 01/02/06

83 Burgh Road 29/09/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 83 Burgh Road 83 Burgh Road Skegness Lincolnshire PE25 2RW Lead Inspector Wendy Taylor Announced Inspection 20th December 2006 11:30 83 Burgh Road DS0000056745.V294688.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 83 Burgh Road DS0000056745.V294688.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. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 83 Burgh Road Address 83 Burgh Road Skegness Lincolnshire PE25 2RW 01754 610777 01754 899873 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) Thera Trust Ms Diane Quarton Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: 83 Burgh Road is a detached bungalow located on a main road leading to the Skegness sea front area. It is in easy reach of the town centre and sea front amenities, including shops, pubs, banks and leisure establishments. There are good local transport links. The bungalow is situated on a good-sized plot, with ample parking and garden space. There are 3 single occupancy bedrooms. The gardens at the rear of the property are laid to lawn and accessible to all service users. There is a garage and a range of outbuildings leading off the parking area to the side of the property. The home is registered to provide a short break service for up to 3 adults with learning disabilities at any one time. Thera Trust maintains the home. A block contract currently exists between the provider organisation and the Local Authority, for the Local Authority to purchase the service as a whole instead of individual placements. The arrangements are clearly stated in the statement of purpose and service user guide as follows, ‘booking placements and fees will be arranged through the practitioner and the Local Authority’. The current cost of the block contract is £206,800 per annum, however this is to be reviewed in the near future. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key announced inspection took place during December 2006 and the visit to the home was carried out over approximately 6 hours on one day. The care and support received by two service users was followed in detail. Individual service user records and general house records were looked at, as wells as staff records. Staff and the registered manager were spoken to and the care being provided was observed. Information already held by the commission was also used as part of the inspection process. The commission are trying to improve the way that we engage with people who use services so that we gain a real understanding of their views and experiences of social care services. We are currently testing a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors to get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. The expert met with service users and staff on their own. The expert said ‘if asked would I like to live here for respite I would say yes because there are very good caring staff.’ What the service does well: What has improved since the last inspection? Since the last inspection visit there have been improvements made to the care plan formats, in that the previous formats were not specific to short break services. The care plans are also more detailed and staff are receiving training to help them develop person centred ‘paths’, which say what service users dreams and aspirations are. There is also a new file audit/updating system in place, and the records of these activities are kept on individual service user files. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a comprehensive assessment and introduction process, which assures them that their needs can be met. EVIDENCE: Assessments are in place in individual service user files, and they contain information about needs such as health, diet, personal care and mobility. There is evidence in the assessment records that service users are invited for overnight stays as part of that process. The registered manager said that when booking stays for people, assessment information such as age, gender and general compatibility are taken into consideration. The expert found that if people cannot express their own needs and choices, families and carers are asked for their involvement in the process. Staff were seen preparing for the admission of a new service user by, for example, completing menu notes and allocating named supporters. A visiting social worker said that potential service users are encouraged to visit the home before booking any stays, and staff will chase up any information that is not clear or detailed enough. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit from detailed and comprehensive care plans and risk assessments. They also benefit from being supported to retain as much control of their daily lives as they are able to. EVIDENCE: Pre inspection information indicates that policies are available for areas such as values, dignity, privacy, choice and risk assessing. Care plans are available in individual files and reflect these issues. They cover needs such as personal care, medication, healthy eating, communication and road safety. There is also a clear record of who is involved in developing the plan, including the service users and their families. Religion, spirituality and preferred daily routines are also clearly recorded. Regular care plan reviews are documented as well as annual reviews with the placing authority. The expert felt that if they wished service users should have a copy of their own plan in their room when they come in to stay, so that they have good access to it. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 10 Risk assessments cross reference with care plans and include areas such as shopping, mobility, choking and hoisting. They provide detailed information on how service users are to be protected and supported. Staff demonstrated a very good knowledge of service users needs and how to communicate with them. The expert felt that staff understood communication needs and they described to the expert the ways in which they can tell what people want. Staff were seen to be encouraging choice by offering a range of items that service users could recognise. The expert felt that service users can be independent and they have a chance to learn new things at the home. They said that the care plan that they saw was person centred, it had lots of pictures and it was reviewed every three months. They also felt that service users have the opportunity to make lots of choices such as who their named supporter is and what room they want to stay in; and they can keep their own money, which is important so that they can do what they want with it. A service user showed the expert around their room, which demonstrated to the expert that they were comfortable in the home. Surveys received prior to the visit show that families and carers think that staff are very supportive and service users receive the care and support they need. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users enjoy access to a wide range of social and leisure activities; and they are supported to maintain a healthy diet that suits their needs and wishes. Menus and the staff rotas could be made available in alternative formats to help with decision-making and recognition. EVIDENCE: Care plans and assessments contain information about service user’s relaxation and leisure choices, and their food and drink choices. Service users were engaging in relaxed art and music based activity during the visit. There are games, puzzles, jigsaws and videos available for service users, and there is evidence in photographs that summer barbeques, garden parties and pub visits are arranged for them. There is a ‘fun file’ available, which contains 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 12 information about the local community activities, and the registered manager said that an individual programme is developed with each service user on admission. The registered manager also said that money raised through a fete during the summer is going towards activity resources, and service users and their families have been asked to decide what resources they want. Pre inspection information indicates that activities such as karaoke, swimming, painting, bowling, shopping and theatre trips are made available to service users. The expert saw service users being supported with activity and staff spending time with them. The expert found that there is an open house policy for visitors and service users can book to stay with people they have met before. The expert also found that service users could carry on with routines that they usually have at home if they wish, such as day services. Menus contain information about the service users likes and dislikes, and their dietary needs are clearly noted, for example diabetes. Alternatives are also available and recorded if someone changes their mind. Snacks, drinks and fruit are freely available. The expert found that service users could help themselves to food and drinks in the kitchen, but felt that signs on cupboards in easy words and pictures to show what is in them would help. They also felt that menus could be available in picture format, to help service users make their choices. Pre inspection information shows that meal times are arranged according to the needs and wishes of the service users. Surveys received prior to the inspection from families/carers show that there are no complaints regarding the food provided, and people thought that their relatives ate very well whilst staying at the home. The expert saw photographs around the home of people who access the service, and felt that it makes people feel ‘part of the family’. They thought it would be a good idea to put peoples names under the photos so that they can be identified, and also that there could be staff photos with names as well, so that service users know who will be supporting with them. The expert also thought that the information on a notice board in the kitchen could be made clearer for service users to read if they want to, so that it doesn’t leave anyone out. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are comprehensive and detailed arrangements in place to ensure that service users have their personal and healthcare needs met. These arrangements are supported by robust policies and procedures. EVIDENCE: Care plans contain information about all of the service users assessed health needs including their health history, immunisation records, emotional, behavioural and mobility needs. For more complex mobility needs the care process is available in photograph form and in a video format, to enable staff to provide consistent and safe support. Consent to using photographs and video formats is clearly documented. Body charts are used for recording any marks or injuries, and where service users are not able to express their consent to take medications, there is a recorded multi disciplinary approach to risk assessing the needs. Pre inspection information shows that there policies and procedures available for medication, pressure relief and moving and handling. Surveys received 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 14 prior to the inspection show that families and carers feel that service users receive the appropriate medical support where necessary, and a comment was made that the service is ‘very satisfactory’. Storage of medication is satisfactory, and each period of admission is clearly defined on the medication administration records. Administration records are fully completed, and there are clear protocols for the administration of medication that is used only when necessary. Information is available about each medication that is used, and records show that staff receive training in the administration of general and more specific medications. Records also show that staff undergo regular assessments of their competence in medication administration. Emergency procedures are recorded clearly in the medication file and staff knew where to find the information. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by robust policies and procedures; and knowledgeable and well trained staff. EVIDENCE: There have been no formal complaints made since the last inspection visit. One concern has been raised about the condition of the driveway, which is currently being addressed. Pre inspection information shows that there are policies available for safeguarding adults, complaints and whistle blowing. There have been no issues raised regarding safeguarding adults since the last inspection visit. Records show that staff have received training in safeguarding adult issues and they demonstrated knowledge and awareness of the subject. Surveys show that families/carers know who to talk to if they are unhappy with anything or wish to make a complaint. The survey also indicated that families/carers feel that staff listen to them and act upon what is said. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from an environment that is comfortable and homely, and which meets their assessed needs. EVIDENCE: The environment is presented as very homely and comfortable, and well maintained in terms of décor and furniture. It was also very clean and tidy. The maintenance programme for the home has highlighted areas work such as redecoration to some parts of the home. The expert said that they liked the festive decorations. Equipment to raise the height of tables so as to accommodate people who use wheelchairs was in place. All cleaning materials and other substances that could be hazardous to health were securely stored. The expert said that there was good equipment available for people who needed help with moving, such as an adjustable bath, 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 17 raised toilet seats and a hoist. They said that the bedrooms were nice and it was ‘lovely’ to have an en suit bathroom in one of the rooms. Although there are pictures on the doors around the house to help service users recognise the room, the expert felt that there could also be ‘easy words’ added to the pictures for those that can read. Surveys indicate that families/carers think the home is kept clean and tidy, and they commented that it ‘was just like home’. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users needs are met by a knowledgeable and well-trained staff team, who are safely recruited. EVIDENCE: On the day of the visit staff were friendly and welcoming. The expert said that the staff were ‘very good and caring’, ‘they are excellent, relaxed and open’. Staff rotas are needs led; they clearly show that the numbers of staff on duty relate directly to the numbers of service users staying in the home at the time, and what their needs are, for example moving and handling. The expert felt that this was a good way to do the rotas. Pre inspection information shows that there are policies available for recruitment, training and supervision. Recruitment records contain application forms, criminal record bureau checks, references and identification. Staff said that there is a good induction programme, which includes them being allocated 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 19 a mentor, and getting to know the environment, care plans, policies and fire safety arrangements. Records confirmed this and show that the induction process is formally recorded in an individual induction booklet. Records also demonstrate that staff undergo a formal review/assessment of their work performance at twelve and twenty four week intervals, as part of the process. Staff said that there is a very good training programme, and they described recent training in how to create a person centred plan. Records show that they have received training in areas such as attitudes and values, managing epilepsy, first aid and managing behaviours (see also Standards 18-22 and 2223). All staff, with the exception of a newly recruited member of the team, have undertaken a nationally recognised care qualification at varying levels. Records also show that staff undergo a six monthly record keeping assessment. Development plans for staff identify training needs for autism awareness and managing choking, and a request has been made to the provider organisation for this training to be provided Records show that staff receive regular supervision sessions and an annual appraisal. There are also records to show that group supervisions are held every other month at staff meetings. Staff said that they get good support from the registered manager and their colleagues. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of service users are protected by robust policies and the implementation of safe practices. They are able to influence service development by way of a comprehensive quality assurance system. EVIDENCE: Records within the home are up to date, clear and detailed. The daily records for service users include information about their mood, appetite, activity and health needs. The commission receives regular monthly reports from the provider organisation about the progress of the home. No accidents/incidents are recorded for the service users who’s care was followed in detail but there is evidence that a clear record keeping and monitoring process in place. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 21 Records show that fire safety checks are carried out regularly, including fire drills and alarm testing. There are risk assessments in place for issues such as fire safety, Legionella and substances that are hazardous to health. Property lists are completed when service users arrive to stay at the home, and records are kept for service users personal money that is looked after by staff. There is a quality assurance policy in place and there is evidence of annual quality audits being carried out by the provider organisations quality department. There is also evidence of audits carried out by service users from other homes, regarding the quality of the support provided. Staff said that they take part in surveys, and the registered manager said that the next service user and family/carer survey is due to be carried out in January 2007. The registered manager said that service users are also involved in the company’s self-advocacy group. Regular audits and updates are carried out on service users files, and the outcomes are recorded on the individual files. The registered manager said that service users are soon to be invited to join the providers policy implementation group. Clear and detailed policies and procedures are available for substances that are hazardous to health, first aid, general health and safety, physical intervention, moving and handling, service users money, record keeping and equal opportunities. Staff said that the registered manager is very supportive and approachable, and a visiting social worker said that the staff are very good at communicating. The social worker also said that service users always give positive feedback about their stays at the home. Surveys from families/carers contain comments such as ‘ we can go away on holiday and not worry’ and ‘(relative) is very, very happy to go and wants to go more times’. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 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 3 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 4 3 X 3 X 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA16 YA17 Good Practice Recommendations It is recommended that a staff rota with photographs of the staff members is made available to service users, so that they know who will be supporting them. It is recommended that picture menus are made available to service users to help with choice and recognition. 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 83 Burgh Road DS0000056745.V294688.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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