Inspection on 17/09/07 for Alpine Care Home

This inspection was carried out on 17th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Alpine Care Home 09/11/09

Alpine Care Home 22/05/06

Alpine Care Home 15/11/05

Alpine Care Home 28/04/05

Alpine Care Home 23/02/05

Alpine Care Home 19/05/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Alpine Rest Home Alpine Rest Home 10 Bradbourne Park Road Sevenoaks Kent TN13 3LH Lead Inspector Justine Williams Key Unannounced Inspection 17th September 2007 09:30 X10015.doc Version 1.40 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 Alpine Rest Home DS0000023925.V348578.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 Older People. 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. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alpine Rest Home Address Alpine Rest Home 10 Bradbourne Park Road Sevenoaks Kent TN13 3LH 01732 455537 01732 455537 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) Mrs Jane Chandra Mangalem Rajamogan Mr Kanagaratnam Kernal Rajamogan Mrs Susan Mary Barth Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Care of one service user with a learning disability is restricted to one person whose date of birth is 12/04/1932. Care of one service user whose date of birth is 05/01/1943. Care of one service user whose date of birth is 21/08/1919 who has Bi-Polar Disorder. 22nd May 2006 Date of last inspection Brief Description of the Service: Alpine Rest Home is a care home providing personal care and accommodation for thirty older people. Mr. and Mrs. Rajamogan own the home, which is situated in a residential area of Sevenoaks. The town centre, with the usual amenities, is a bus ride from the home. There is a main line railway station half a mile away. The house is a large detached property with parking to the front and a garden to the rear. Accommodation for residents is over two floors accessed by a lift. There are eighteen single and six shared rooms. One of the shared rooms has an en-suite bathroom. There are two large lounges, a dining room and a visitors’ room. There are bathrooms and toilets on the first and second floors. At the time of writing this report, fees ranged from £325 to £500 per week. Alpine Rest Home employs care staff, working a roster, which gives 24-hour cover. Ancillary staff includes two cooks, a kitchen assistant and domestic staff. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on 17th September 2007 between 09.45am and 2.45pm by Regulatory Inspector Justine Williams. During that time residents, relatives, staff and the manager agreed to speak with the inspector both in public and privately. This report contains assessments made from observations, conversations and records, case tracking and a tour of the premises. Feedback was given during and at the end of the inspection. As part of the inspection process surveys were sent to service users, GP’s, health care professionals, care managers and relatives of residents. Some specific comments made included: “I hope the Alpine never closes” “we consider ourselves very lucky that our (relative) is being looked after and cared for at the Alpine” “the home is my second home” “a very friendly family atmosphere” “the communal areas are tired and drab, the general environment needs seriously up grading” “I have found nothing in 3 ½ years to complaint about” What the service does well: Alpine Rest Home is particularly good at accommodating people with problems in addition to older age. The service has a good working relationships with local placing agencies who offer a support network. Care is taken to welcome new residents to the home. Residents are treated as individuals with the dignity, rights and respect due to older people. Written care plans support staff’s sound understanding of each person. Health care is well managed. Residents can follow their own pursuits and activities, having a range to choose from. They can maintain contact with friends and family and know such people will be welcomed to the home. Home cooked and well presented food is provided with dietary needs met. Residents have opportunities to talk about the service and if necessary, make a complaint and be listened to. Residents have their needs met by staff who Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 6 the residents think are kind and caring, who enjoy working at the home and providing a good standard of care. Servicing of supplies and equipment is carried out. What has improved since the last inspection? What they could do better: The décor in some areas is looking very tired and tatty, with paint work damaged and peeling, stained carpets, and particularly bathrooms and toilets looking in great need of refurbishment. Completion of this work will ensure residents have a comfortable and pleasant home in which to live. The potential hazards in the bathroom, a damaged bath hoist chair, heavily lime scaled bath and towels stored in open shelving upstairs need to be addressed to maintain residents health and safety. Planned refurbishment of the shower room will make showering more pleasant for residents. Continued efforts are needed to bring the number of staff with NVQ’s up to 50 are needed to provide a skilled workforce. Staff must receive timely training updates and training in first aid, must be sought so a trained first aider is on duty every shift, and when care staff are required to prepare food they must have food hygiene training. Health and safety and COSHH training must also be sought. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to move into the home through sound admission processes. EVIDENCE: The home supplies prospective residents and their families with the statement of purpose and service users guides. These documents are regularly updated and residents found them useful when making their initial decision to move in to the home. Residents said they or their families had visited the home prior to moving in and they were made to feel welcome by the staff. Resident’s needs are assessed prior to them moving in, the assessment is done by the manager or other senior member of care staff. Copies of assessments undertaken by care management are requested. The home continues to enjoy good working relationships with Darent House, and continues to provide care Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 10 for individuals suffering from some forms of mental health problems. The home continues to gather information from various sources, such as district nurses, GP’s CPN’s and other health and social care professionals prior to offering admission. Residents said they or their relatives had visited the home prior to moving in, and felt assured the home could meet their needs. Intermediate care is not provided at Alpine. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are well managed. EVIDENCE: Each resident has a plan of care, based on the assessment. Some residents spoken with were aware of their care plans, and had been involved in drawing them up. The care plans set out in good detail how resident needs are to be met. The daily records contained reasonable detail about how resident spent their days. Staff continue to have a good understanding of resident needs and individual personalities, likes and dislikes. Records include any specific health problems which staff said would be monitored. The medical record is very good as it gives clear detail of changes in a condition, relevant dates and can be easily shared with medical staff on a need to know basis. Residents spoke of having chiropody, dental, optical, physiotherapy and district nurse visits in house. The home now monitors all residents weight and evidence of action taken to address weight loss was seen. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 12 The home has a medication policy which staff adhere to and the home has recently changed to the MDS system, staff have received training in the new system. Records are held to evidence that medication has been administered as per prescribers’ directions to the correct person. The manager carries out regular medication audits. Residents said they have good relationships with the staff, and gave examples of how staff treat them with respect and ensure their privacy and dignity are maintained. Staff knock on residents doors and ask before entering, and address residents by their preferred name. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a setting which recognises them as individuals with the right to exercise control over their lives, who they see, what they eat and what activities they want to do. EVIDENCE: Residents spoke enthusiastically about the range of activities offered at Alpine. Some comment cards stated that more outings would be very welcome. Whilst the home does not employ a full time activity co-ordinator there is a full programme of activities which includes several external groups visiting the home to conduct art classes, music and movement, shows, guitar playing, etc as well as trips out, musical bingo, etc. the home has a cat looked after by the residents and staff. Residents who hold religious beliefs have local churches and visiting ministers both High Church and Church of England. The home has recently organised for school pupils to visit regularly to help with the tea trolley and chat to residents. A local firm provides a driver and minibus weekly to take small groups of residents out, on the afternoon of the site visit residents were going to a local garden centre. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 14 Visitors said the home was always very welcoming, and that they were kept well informed of their relatives wellbeing. Residents said they were particularly pleased at the welcome their relatives received when visiting the home, and that their relatives are always offered a drink. The visitors’ book recorded a number of regular visitors. A visitors’ room is available, should residents choose not to use their bedrooms or communal areas. Residents felt in control and said they made decisions about there own lives. Residents may bring in their own furniture and personal items. Residents spoke very positively about the food, with special diets being catered for. Residents said there is always a good choice of meals which are nicely presented. Plenty of drinks were offered at the dining table, when residents were seated in the lounge and in bedrooms. Kitchen stocks confirmed that the cooks had access to a range of good quality, varied and properly stored ingredients. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to people who listen to any concerns and who will take action to ensure they are protected from abuse. EVIDENCE: The home has not received any complaints since the last inspection. Minor expressions of dissatisfaction are recorded and acted upon. Residents said they felt at ease to discuss any problems with the manager or any member of staff, and felt confidant any concerns they had would be listened to and resolved. Information about how to contact the CSCI is also displayed within the home. The manager has produced a pictorial complaint policy for their more confused residents. Staff had a good understanding of the procedures in place within the home for the protection of residents from potential abuse. Written policies and procedures are available for staff. new members of staff read through such policies as part of the induction. Where there are any concerns regarding adult protection, the home fully cooperates in the process to ensure practises are implemented to address identified risks. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have a homely environment in which to live which would benefit from redecoration and refurbishment. EVIDENCE: The décor of the home would benefit from renewal in several areas, some carpets in corridors and communal areas are stained, paint work is chipped and damaged, the ceiling paint in one area is flaking. One area on the ground floor near the shower room smells damp and musty. The toilets, shower room and one bathroom upstairs would benefit from refurbishment and redecoration, one of the toilet pans is badly stained, one toilet seat is damaged and needs to be replaced or made good. The assisted bathroom upstairs has damage to the hoist seat, which presents a health and safety issue as well as an infection control issue, as residents could receive cuts and abrasions, and there is no Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 17 longer a continuous surface making it difficult to clean properly. The bath is heavily lime scaled again rendering it difficult to clean properly, clean linen should not be stored in bathrooms particularly on open shelving due to potential cross infection hazards. The manager has purchased a gate to restrict access to the attic rooms but it has not yet been fitted. The home has a vacancy for a maintenance person, but hopes to conduct interviews soon. The manager confirmed the home complies with requirements of the fire service. Building work is being conducted near the lounge with an additional room being built to provide more communal space for residents. Residents and relatives said the physical environment could be much improved. The home was free from offensive odours in all but one bedroom, the manager confirmed the carpet in this room was frequently cleaned, but replacement may be necessary. The laundry was tidy and well organised, the home does not employ specific laundry staff, care staff undertake laundry duties. Soiled items and clinical waste are dealt with appropriately. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a staff team who understand and anticipate residents’ needs and wishes. Residents would be better protected by ensuring staff receive regular training updates and a review of NVQ qualifications. EVIDENCE: Residents said they do not have to wait long when they call for assistance and have their personal care needs attended to at a time they refer, indicating that the staffing numbers are sufficient. Residents continue to have very good relationships with staff and speak particularly fondly of the manager. The roster records the full name of all staff working on shift and shows where shift vacancies occur and how these have been covered, in addition a separate record is kept of hours actually worked. The manager works in a hands on capacity if necessary. Staff follow an induction process which includes duties shadowing a more experienced member of staff, a process confirmed by both staff and residents and now well evidenced in documentation. The manager is in the process of ensuring the induction contains all the elements recommended in the skills for care induction. The number of staff having attained NVQ’s is 3, the staff who are registered nurses overseas, but have not attained registration in the UK cannot be Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 19 counted as NVQ equivalent according to Skills for Care. Therefore the home has well under 50 of carers with NVQ. Personnel records now contain all the information required by regulation, and in addition a transcript of questions asked with candidates replies are kept. The manager keeps a training matrix to enable her to track training completed and training due for all members of staff. The matrix indicates that further training must be organised soon in health and safety, COSHH training for cleaning staff, food hygiene training for staff responsible for food preparation, first aid training for more staff is also needed so that a qualified first aider is on duty every shift. Several staff have received dementia training and other mental health training, as well as other training pertinent to the needs of the relatives. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a needs led and safe service, which is run in their best interests by a manager and staff who are committed to providing a good quality of life for older people. EVIDENCE: The manager is competent to run the home, has been in post for four years and has had previous experience of residential care. She has obtained an NVQ level 4 in management and care. Residents consider the manager is available and approachable. Staff take on responsibilities in the manager’s absence but recognise final responsibility as being the managers and have systems to contact her if necessary. All spoken with felt that the manager was committed Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 21 to providing a good standard of service and had the needs of older people at heart. The manager has some quality assurance systems in place such as surveys, residents and staff meetings and documentation audits and should now collate the information to inform areas of strength and areas for improvement. The manager provides supervision for staff, but is not managing to provide supervision as frequently as recommended, the manager hopes that employing a deputy will allow some work to be delegated. The self-assessment completed by the manager indicates that the home complies with guidance and legislation regarding health and safety, including regular maintenance and checks of equipment etc. Staff spoke of fire drills attended and when fire alarms were tested. They were aware of action to take in the event of fire. The proprietors or their representatives take an interest in the overall running of the home and a visit under regulation 26 is carried out and recorded monthly. Alpine Rest Home DS0000023925.V348578.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP19 Regulation 23 (2)(d) Requirement Timescale for action 30/11/07 2 OP26 13 (4)(c) 3 OP30 18 (1)(c) The registered person shall that all parts of the home are kept clean and reasonably decorated, in that peeling, damaged and stained paintwork be made good, stained carpets be made good or replaced. 30/10/07 The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated in that damage to the bath hoist seat be repaired, and infection control potential hazards be addressed, including the lime scale on the bath, damaged toilet seat, clean linen storage to be reviewed. The registered person shall 30/11/07 ensure staff receive training appropriate to the work they are to perform, in that first aid trained staff must be working on every shift, care staff preparing food must have up to date food hygiene training, staff should receive health and safety training. Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 24 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 OP19 OP28 Good Practice Recommendations Consideration should be given to restricting access to the staircase leading to the attic room It is recommended that a review should be undertaken to ensure that a minimum ratio of 50 of the care staff team will be qualified to NVQ level 2 or above by the end of 2005. This recommendation is repeated from the inspection of 15.11.05, and 22.05.06 Action should be taken to enrol staff on NVQ programmes as soon as possible. 4. OP33 It is recommended that the home’s quality assurance system should be expanded to include a development report. Staff supervision should include recorded one to one meetings with new staff as part of their induction procedure and at intervals of not less than 6 times a year. 5. OP36 Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Alpine Rest Home DS0000023925.V348578.R01.S.doc Version 5.2 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!