Inspection on 24/10/06 for Alsager Court Care Centre

This inspection was carried out on 24th October 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 but made no statutory requirements on the home.

Other inspections for this house

Alsager Court Care Centre 08/05/08

Alsager Court Care Centre 04/07/07

Alsager Court Care Centre 27/04/06

Alsager Court Care Centre 24/10/05

Alsager Court Care Centre 04/11/04

Alsager Court Care Centre 15/06/04

Alsager Court Care Centre 20/02/04

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

CARE HOMES FOR OLDER PEOPLE Alsager Court Care Centre Sandbach Road North Church Lawton Stoke On Trent Staffordshire ST7 3RG Lead Inspector Sue Dolley Unannounced Inspection 09:30 24th October and 9 November 2006 th 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 Alsager Court Care Centre DS0000006648.V310567.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. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alsager Court Care Centre Address Sandbach Road North Church Lawton Stoke On Trent Staffordshire ST7 3RG 08453 455743 01270 883256 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 Sally Anne Manby Roberts Mr Jeremy Walsh Mrs Sylvia June Knox Care Home 27 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (27) of places Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 27 service users to include: Up to 27 service users in the category of OP (old age not falling within any other category. * Up to 15 service users in the category of care with nursing (N) * Up to 7 service users in the category of DE(E) (dementia over 65 years of age) * The following bedrooms are excluded for the provision of care with nursing (N): 2,3,7,8,11,12,24,25,26 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The registered provider must provide staff to meet the dependency needs of service users at all times and shall comply with any guidance that may be issued through the Commission for Social Care Inspection. 27th April 2006 * 2. 3. Date of last inspection Brief Description of the Service: Alsager Court Care Centre is a 27- bedded care home for older people. Up to a maximum of 15 residents may have nursing needs and up to a maximum of 7 residents may be over 65 years of age and have dementia care needs. The home is situated off a busy main road in a residential area of Church Lawton, near Alsager. It provides ground floor accommodation and is set within two acres of landscaped gardens. There are 24 single rooms and 2 rooms, which could be shared to a maximum of 27 places. 16 of the rooms have en-suite facilities. The current owners took over the running of the home in September 2001.The fees for Alsager Court currently range from £343.34 to £680.00 per week. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 24th October 2006 and lasted almost four hours. A Regulatory Inspector and a Regulatory Manager visited along with a specialist inspector who looked at medication. The visit was to undertake the second of two key inspections between 1st April 2006 and 31st March 2007. Feedback to the site visit took place on 9th November 2006. The visits were just one part of the inspection process. The registered manager was asked to complete a questionnaire to provide up to date information about the services available. Information received since the last site visit was considered. During the visits various records were seen and the premises were looked at. A number of residents were also spoken to and questionnaires were completed with a small number of the residents to find out their views about the care home and about the care provided. What the service does well: What has improved since the last inspection? Since the last site visit the management of the home has ensured that the person in charge arrangements are clearly stated. Action has been taken to try to bring about improvements in administration, management and recording of medication and residents now have more regular opportunities to participate in activities. Alsager Court Care Centre DS0000006648.V310567.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. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 7 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 Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. Pre-admission assessments are completed by a Registered Nurse to ensure prospective residents needs could be met within the care home. EVIDENCE: The pre-admission documentation and initial assessments for three recently admitted residents were checked and these residents were case tracked to ensure their needs had been identified, addressed and met. All three residents had a pre-admission assessment completed by a Registered Nurse to ensure their needs could be met. The assessment summaries provided detailed information to explain specific care needs to care staff and nursing staff and to identify the action to be taken to assist residents in all aspects of daily living. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 9 The pre admission assessments had been completed thoroughly. One pre admission assessment had taken place whilst the prospective resident was in hospital with a close relative and a social worker present. Another pre admission assessment had been completed whilst the prospective resident was in another care home. Each of the three care files checked included pre admission assessment information which been gathered from a variety of sources. The assessments had involved carers, family members and other social contacts and relationships. This helped to build a clear and accurate picture of the prospective residents care needs and enabled staff members at the home to develop plans of care for daily living and longer -term outcomes. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to this service. Although residents are well looked after in respect of their health and personal care needs, the recording and administration of medication needs improvement to ensure all residents receive their medication as prescribed. EVIDENCE: The three plans of care checked detailed action to be taken by staff to ensure all aspects of health and personal care needs were met. Risk assessments were conducted appropriately. One resident had gained weight in their first four weeks at the home and had regained independence to feed, and now needed only minimal assistance. The resident had been appropriately referred to the continence nurse. As a result of the involvement continence had improved. The General Practitioner had been alerted when a resident had difficulty in swallowing tablets, the medication was reviewed, some been discontinued and some had been prescribed in liquid form. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 11 Emotional wellbeing and skin integrity had also been closely monitored and recorded and each of the residents had been appropriately referred to health and social care professionals to gain improvement. The care files recorded individual preferences, likes and dislikes. Pen profiles had been completed and gave details of family members and of people important to residents. They also included information about hobbies and past occupations. The residents interviewed confirmed that they are able to get up at the time of choice and take meals in their own room or in the dining room. One of the three residents care files checked did not include information to be used ‘in the event of their death’, but all next of kin details had been completed. A Commission for Social Care Pharmacist inspected the medicines due to concerns identified by the lead inspector at the last unannounced inspection. Medicines are stored in a secure room that has no hand-washing facilities and needs redecorating and tidying up. There is a good range of metal cupboards, trolley, refrigerator and controlled drug cupboard. Room and refrigerator temperatures are recorded dailyand are satisfactory. Although the nurse on duty knew whom the prescribed food supplements were for these were not marked with the residents’ names. Also sundry items like sterile water and saline were managed as stock. It was good to see that one resident’s preference for chocolate flavoured Ensure had been met but this was not recorded in the care plan. There was an assessment form for self –medication but generally residents were not able and staff gave them their medicines. Only four of the nine staff able to give medicines were included in the revised (11/06) specimen signature list. Eye drops were dated when opened. Controlled drugs were well managed and there were records of audits of controlled drugs. Waste disposal facilities are fine and there are two books to record items put into the waste bins, one for controlled drug patches and one for the rest. Many of the records of the receipt, administration and disposal of medicines were completed to the required standard and included a signed note that they had been checked with the previous record. When doses were not given staff frequently used the “G” code and made a note on the back of the record sheet. These are on the whole good but occasionally entries cannot be read easily. Three residents had unexplained gaps in records of giving their medicines. Only one resident prescribed a variable dose of painkiller did not have the dose recorded, others were recorded well. Residents prescribed Warfarin have handwritten notes of the dose stapled to their record. These are not signed or dated. The yellow anticoagulant book would be better kept with the administration records. One resident had been recorded given 2mg of Warfarin on 6/10/06 rather than the 3mg prescribed. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 12 Another resident was prescribed an antibiotic cream twice daily but was only recorded having it in the morning for 11 days. Three residents had doses of four medicines signed as given but the tablets were in the pack. Three more were the same except there was a record of a recently refused dose and it is possible that the dose had been given from the wrong blister. Another resident’s night sedation did not follow the days in the blister pack. A resident had been given a tablet on the morning of the visit but it had not been recorded. The nurse on duty remembered and made the record late. One resident was recorded to have received a course of antibiotics and a medicine to relieve itching on 23/10/06. The antibiotic course was started at 17.00 hours but the other medicine was marked out of stock at 22.00 hours. Alsager Court Care Centre DS0000006648.V310567.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. There is opportunity for residents to participate in activity to meet their needs, match their expectations and preferences. EVIDENCE: Residents’ interests are recorded within their care files and residents meetings provide a forum for people to discuss their social and recreational needs. A new Activity Co-ordinator is in place within the home and ensures with the manager that arrangements are made to enable residents to engage in local social and community activities of their choice. The activities co-ordinator also works within the home as a member of care staff. The last residents meeting on 1st September 2006 was attended by the activities co-ordinator and possible activities were discussed. The activities log provided evidence of small group activities including for example, dominoes, beetle drives, baking, music and movement and quizzes. Logs of individual activities were seen and gave details of one to one activities arranged and undertaken with residents. Several residents had enjoyed beauty therapy and conversing about their past experiences and culture. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 14 In the reception hall there is a board displaying photographs of past activities and a weekly programme of planned activities is also on display. Residents confirmed that they had recently enjoyed trips to The Blue Planet Aquarium and to Blackpool and several residents had enjoyed church services within the home. A Christmas Fete, Clothing Fayre and Christmas Party are currently being planned. The Statement of Purpose and Service User Guide shows 15 hours per week of staff time is allocated for basic social, recreational and cultural activities. In telephone discussion with the activities co-ordinator several days after the site visit, it was confirmed that she had identified hours amounting to three, six hour sessions per week in which to plan organise and undertake specific activities. Other staff members help to undertake activities at various other times. On four separate occasions between 18th September and 17th October 2006 it had been necessary to cancel planned activities due to a lack of care staff. Occasionally the activities co-ordinator has needed to work as a carer. Alsager Court Care Centre DS0000006648.V310567.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. Past concerns and complaints have been few and records provide details of appropriate action taken to resolve any issues. EVIDENCE: No complaints have been received by the home or made to the Commission for Social Care Inspection since the last site visit. The Statement of Purpose and Service User Guide contains a clear complaints policy and procedure with appropriate contact addresses to enable residents and their representatives to give details of their complaints and await a response. The complaints policy and procedure is displayed on the notice board in the reception hall and there are suggestion/comment sheets available for residents and their supporters to use. Alsager Court Care Centre DS0000006648.V310567.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. Residents live in a well maintained, and clean home which is decorated and furnished to a good standard providing a comfortable and homely environment for residents. EVIDENCE: A tour of the premises was undertaken and included the communal lounge and dining areas, and five bedrooms. The premises were well maintained, fresh, clean and welcoming. In discussion with residents positive comments were made regarding the constant and good standard of cleanliness throughout Alsager Court. Several bedrooms were visited with the manager and the use of particular bedrooms for nursing care was discussed and agreed and are to be reflected in the conditions of registration. The home is suitably equipped to aid mobility and the residents’ rooms are personalised and arranged to suit their needs. It is difficult for residents with wider wheelchairs to safely negotiate some of the doorways within the home. The grounds are kept tidy and attractive and are accessible to residents. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 17 There was evidence of regular wheelchair maintenance to ensure safety. Monthly emergency lighting checks had been undertaken and recorded. The registered manager was advised that one of the central heating boilers was due for servicing. Information supplied after the site visit confirmed that the servicing of the boiler had been scheduled to take place week commencing 30th October 2006. The manager explained that she was due to have discussion with the estates manger, as she understood that one of the boilers could be in need of replacement. Alsager Court Care Centre DS0000006648.V310567.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. Residents’ needs are met within the home although the home sometimes relies heavily on the support of agency staffing to maintain staffing levels. The home’s recruitment policy, procedures and practices help to protect residents. EVIDENCE: The staffing rota clearly recorded and identified person in charge arrangements. There are sufficient numbers of staff recorded on the duty rota with appropriate skills to meet the needs of residents. Difficulties have arisen due to staff sickness and an inability to cover shifts with agency staff at short notice. The Commission for Social Care Inspection was notified of the staff shortages on these occasions. Some agency staff members are regularly employed and this provides continuity to residents. Between 6th and 23rd October 2006 thirty shifts, were covered by agency staff. This had mainly been to cover for a period of annual leave. Much of the recruitment information is stored on computer. The visual quality of the information stored has been improved. A sample of recruitment documents, were checked and were satisfactory. The recruitment process was evidenced and was thorough. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. The home strives to run in the best interests of residents to promote and protect their health safety and welfare. EVIDENCE: The registered manager is a qualified nurse and is competent and experienced in the delivery of care to older people. She has an open management style, is approachable and has achieved the registered managers award. The registered manager has twelve hours supernumerary management time each week. A positive and inclusive atmosphere has been encouraged within the home and both residents and staff feel supported. Monthly monitoring visits are undertaken to Alsager Court, to monitor the practice and conduct within the home, and to provide guidance to management and staff during the visits. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 20 Monthly written reports of these visits are available and contain residents’ views about the standard of care and support provided. A quality monitoring process is in place and the results of the latest quality assurance audit were on view on the reception hall notice board and provided positive comments about the admission process, accommodation, the care received and domestic services provided. The results are also published in the Statement of Purpose and Service User Guide and relate to the year up to June 2006. The registered manager ensures that risk assessments are carried out and recorded in respect of all safe working practice topics. The accident records were checked and accidents were thoroughly recorded. The fire policies and procedures manual was checked and provided evidence of satisfactory fire safety checks and training. Occasionally some of the checks to be undertaken weekly on the fire alarms, fire doors and sounders had been recorded as being checked at fortnightly intervals. Advice was given regarding this at feedback to the inspection and the registered manager will ensure all future tests are undertaken and recorded weekly. The pre inspection questionnaire indicated that the emergency call system has regular in house checks. The records seen, indicated that the nurse call system had been checked on 17th October 2006. No other checks could be evidenced between February and October 2006. The registered manager was advised of this and undertook to provide evidence of an annual check undertaken by a contractor and undertook to ensure regular in house checks were recorded. Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 1 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X X X X 2 Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 22 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. Standard OP9 Regulation 13 (2) Requirement The registered person must make arrangements for medicine records to be correct, clear and made at the time of giving the medicines. (Similar requirements were made at four previous inspections on 4th and 9th of November 2004, 9th May 2005, 24th October 2005, 27th April and 5th May 2006). Timescale for action 31/12/06 2. OP9 13 (2) The registered person must 31/12/06 make arrangements for residents to have their medicines to the prescribed directions. (Similar requirements were made at four previous inspections on 4th and 9th of November 2004, 9th May 2005, 24th October 2005, 27th April and 5th May 2006). Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The registered person should consider improving the medicine storage room, particularly providing a hand washbasin. Ensure that the information to be used ‘in the event of a death’ is obtained and recorded within the care file. Alsager Court Care Centre staff could sensitively obtain this information. The registered person should ensure that the nurse call system is regularly checked and serviced and appropriate records are kept to ensure it is maintained in good working order. 2. OP11 3 OP38 Alsager Court Care Centre DS0000006648.V310567.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Alsager Court Care Centre DS0000006648.V310567.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. 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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