Inspection on 30/07/08 for Applegarth Care Home

This inspection was carried out on 30th July 2008.

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

Applegarth Care Home 08/08/06

Applegarth Care Home 02/11/05

Applegarth Care Home 10/06/05

Applegarth Care Home 21/06/04

Applegarth Care Home 04/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Applegarth Care Home 24 Huntercombe Lane North Maidenhead Slough Berkshire SL6 0LG Lead Inspector Julie Willis Unannounced Inspection 09:30 30th July & 8 August 2008 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 Applegarth Care Home DS0000057355.V367040.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. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Applegarth Care Home Address 24 Huntercombe Lane North Maidenhead Slough Berkshire SL6 0LG 01628 663287 01628 663987 applegarth.care@Btconnect.com 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) Mr Harbhajan Surdhar Mrs Jennifer Margaret Poole Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 18. Date of last inspection 8th August 2006 Brief Description of the Service: Applegarth is a privately owned care home providing personal care and accommodation for up to eighteen people over the age of sixty-five years, who have care needs associated with old age. The home is situated in an urban location approximately five miles from Slough Town Centre and a few miles from Maidenhead. The fees are £550 per week. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. This unannounced inspection took place over two days. The first visit was carried out on the 30th July between 10am and 2.30pm. The inspector was concerned about some fire safety issues during the inspection and requested the Fire Authority carry out a joint visit that day. As a result the Fire Authority made a number of immediate requirements. The second visit took place on the 8th August between 9.45am and 3.15pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. Prior to the visit a questionnaire was sent to the Manager along with survey and comment cards for residents and visiting professionals such as doctors and nurses. Any replies were used to help form judgements about the service. Consideration has also been given to other information that has been provided to the Commission since the last inspection. The inspector toured the building, examined records and met all of the residents. The inspector also spent time talking informally to staff and observing how care was being delivered to the residents. From the evidence seen by the inspector and comments received, the inspector considers that this service has a good awareness and understanding of equality and diversity issues and would be able to provide positive outcomes for residents in the areas of race, ethnicity, age, gender, sexuality, disability and belief. The inspector gave feedback about her findings to the homes Proprietor and Manager at the end of inspection. There were no legal requirements made as a result of this inspection. The Commission has received no information concerning complaints since the last inspection. What the service does well: All of the residents told the inspector that they liked living at the home and that the service provided was good. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 6 People felt that management are approachable and open to comment. They said that they felt “part of the family, as the home was small and friendly”. Particular praise was given to the staff team. Residents feel that their care is provided in a manner that respects their right to be treated with dignity, privacy and respect. Residents say that staff are caring and kind and there is enough staff on duty at the home to meet the needs of residents effectively. Records were well-kept and up-to-date and provided staff with the information they need to provide the right care. Staff are well trained and most have achieved professional qualifications in care to further enhance their skills and knowledge. Residents said that the food was good and was provided in an unhurried manner in comfortable surroundings. There is a choice and food is well cooked and nutritious. Resident’s visitors are warmly welcomed and may visit at anytime. They are encouraged to remain involved in the resident’s care and welfare and are consulted about issues that may affect them. What has improved since the last inspection? What they could do better: There are no new requirements arising from this inspection. Please contact the provider for advice of actions taken in response to this Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 7 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. Applegarth Care Home DS0000057355.V367040.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 Applegarth Care Home DS0000057355.V367040.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): Standard 3 People who use the service experience good quality outcomes in this area. Residents are fully assessed prior to admission to ensure the home will be able to effectively meet their need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From examination of pre-admission documentation it is clear that people are only admitted to Applegarth if the service is satisfied that staff have the skills, knowledge and ability to meet the individuals needs. All prospective residents are fully assessed at home or in hospital. The assessment is carried out by the homes Registered Manager. Information is sought from a range of health and social care professionals as well as the resident themselves and family members. This enables the service to build up a picture of the residents needs and to plan fully for their admission. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 10 The documentation for five residents was examined and the residents were case tracked from pre-admission to date. From discussion with staff, management and residents it is evident that significant planning is undertaken pre-admission to ensure that the residents transition to the home goes smoothly. This includes ensuring that the home has in place any specialist equipment needed by the individual during their stay. The tool used for the purposes of assessment was holistic and comprehensive in detail and gathered sufficient information to ensure that the home would be able to effectively meet the resident’s need. A range of assessment tools were being used routinely to assess the resident’s nutritional needs, communication needs, risk of falls, continence needs, mental state and level of mobility. Manual handling risk assessments and ‘safe systems of work’ had been developed to reduce the likelihood of injury. All residents consulted spoke positively about their experiences at the home. A sample of their comments included “staff are very friendly, I like it here”, “I’m happy enough, the foods good, its nice and warm and I have everything I need, what more could I ask” and “I think its OK, I would sooner be at home but I need someone to help me and people are kind here”. Applegarth Care Home DS0000057355.V367040.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): Standards 7, 8, 9, 10 People who use the service experience good quality outcomes in this area. Residents are encouraged to make choices about their lives and to take everyday risks. The written records accurately reflect the individual needs, aspirations and lifestyle choices of each resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the care plans for five residents evidenced that the resident’s health and personal care needs were well met. Information was up-to-date and accurate and sufficiently detailed to enable staff to know how each resident wishes to be cared for. Care plans were being reviewed at regular monthly intervals to ensure that they continued to reflect the needs of residents. The daily records were a clear account of actions and events that occurred to the resident over a twenty-four hour period. Risks to residents had been fully assessed using a range of assessment tools and guidelines were in place to reduce the likelihood of occurrence. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 12 There is a need to ensure that people’s weights are accurately recorded on a regular basis (at least monthly). Records should be kept of what action has been taken to highlight issues of significant weight loss and the outcome of any referral made to health professionals for their advice and support. Residents that spoke to the inspector expressed little interest in the development and review of their care plans but felt that they could ask to see the records if they wished. One resident said, “I let them get on with it, as long I get my food three times a day, I’m happy” another said, “I don’t know what records they keep, I suppose I could ask to see them if I wanted to, but I’m not that bothered”. Residents are provided with access to health and social care professionals for advice and support when necessary. General practitioners, community nurses, and community psychiatric nurses are regular visitors to the home and provide advice to the staff on all aspects of care. Residents confirm that they regularly see their GP and are referred to hospital when necessary. Routine screening and preventative treatments are provided to all residents. From examination of the medication administration system and discussion with senior staff it is clear that the home follows best practice guidance when administering drugs. Senior staff have been trained in the administration of medication and are regularly in receipt of refresher training. A monitored dosage system is in operation at the home and medication is delivered to the home on a monthly basis. Storage systems are effective and disposal systems are safe. Two signatures are required when administering any controlled drugs and these drugs are stored separately as legislation requires. Applegarth Care Home DS0000057355.V367040.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): Standards 12, 13, 14, 15 People who use the service experience good quality outcomes in this area. A range of activities is offered that provide opportunity for mental and physical stimulation. Residents are encouraged to maintain contact with their family and friends and are able to have visitors at any time. The home provides a varied and nutritious menu designed to meet the needs of its residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with staff and residents it was clear that activities are offered to residents at the home on a daily basis. On the afternoon of inspection several of the residents were engaging in a general knowledge quiz and others were chatting one-to-one with the staff. There was a relaxed and friendly atmosphere at the home throughout the period of inspection with lighthearted banter and cheerful laughter being the norm. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 14 Usage of the gardens has been significantly curtailed of late due to the extensive building works that are being carried out at the home but there are plans to have the whole area landscaped when the works are completed to provide a pleasant area for residents to enjoy in the clement weather. Residents confirm that their visitors are made most welcome at any time and are offered appropriate hospitality during their visits. A number of social events are held throughout the year which promotes community involvement and which provide residents families with the opportunity to engage with the staff and residents on an informal and regular basis. Examination of meal provision indicated that the home follows a revolving menu. There are alternatives provided to the main menu each lunchtime and two choices are provided for tea. Lunch on the day of inspection was fish and chips, which was being enjoyed by all. Special diets can be catered for including diabetic, vegetarian or pureed meals. Discussion with residents evidenced that the food was well cooked tasty and plentiful. A number of residents made comments such as “the food is very tasty” and “always a choice” Applegarth Care Home DS0000057355.V367040.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): Standards 16 & 18 People who use the service experience good quality outcomes in this area. The home has a satisfactory complaints system. Residents feel their views are listened to and acted upon. Residents are protected from abuse and exploitation by well-trained and competent staff that can demonstrate knowledge of the homes abuse of vulnerable adults and whistle-blowing policies. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of how to make a complaint are displayed in the home. The complaint policy meets the requirement of Standard and Regulation. It provides information on how to make a complaint and the formal stages in procedures. Examination of the complaint records indicated that there have been no complaints made to the home since 1st April 2007. Residents spoken with at the time of inspection said that that they felt confident that they could approach staff with any concerns or complaints and these would be taken seriously and acted on without delay. There has been no information about complaints reported to the CSCI about the home since the last inspection. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 16 There are written policies covering safeguarding adults and whistle-blowing. These make clear the vulnerability of people in residential care and the duty of staff to report any concerns to a person in authority. There was evidence in staff files and from discussion with staff, that they receive training in ‘Safeguarding Adults’ as part of their formal induction to the home. This training is later refreshed and consolidated when staff undertake NVQ training in which it forms a core module. Service users confirm that they feel safe at the home and are well cared for by competent and caring staff. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 17 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): Standard 19 & 26 People who use the service experience adequate quality outcomes in this area. The current building works detract from the homeliness of Applegarth due to the noise and disruption of builders. However, standards of décor and furnishings in other parts of the building offer residents a comfortable place to live. Standards of hygiene are good throughout. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is currently undergoing extensive building works, which are due to be completed in the next few weeks. Several bedrooms have been completely rebuilt, new corridors have been made and the staff office has been reconfigured to make better use of available space Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 18 The Manager and Proprietor recognise the need to keep disruption to residents to a minimum. Builders have been directed to keep fire escape routes clear and the front car park tidy and safe. The Proprietor has given an undertaking to replace the carpets on the ground floor on completion of the works. Likewise fences will be replaced to the rear of the property and the gardens will be fully landscaped. The Fire Authority will be revisiting the home on completion of the works to check compliance with requirements from their last inspection, which took place on the 30th July. The inspection took place at the request of the CSCI inspector who noted some serious health & safety deficits on day one of the inspection of the home. These deficiencies had been remedied by the second visit and are therefore not subject to requirement at the end of this report. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 19 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): Standards 27, 28, 29, 30 People who use the service experience good quality outcomes in this area. There were sufficient numbers of staff on duty at the time of inspection to meet the needs of residents effectively. The skill mix of the staff team was appropriate for the size, layout and purpose of the home. Recruitment policies and procedures at the home are robust and transparent and ensure the safety of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the recruitment files for the 4 most recent employees indicated that all necessary checks are undertaken on prospective staff to ensure the safety and protection of residents. Records were well kept and met the required standard. Staff appeared to have a good understanding of how their individual role benefits the work of the team and a thorough knowledge of the key values that underpin their work with residents. Staff are offered opportunities to gain qualifications to further enhance their knowledge and skills such as National Vocational Qualifications at level 2 & 3. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 20 All staff are provided with refresher training at regular intervals, in core skills such as fire safety awareness, health & safety, first aid, manual handling and infection control to ensure resident safety. From records and discussion with staff it was clear that all staff have been properly inducted and they have completed a period of shadowing more experienced staff to ensure that they are confident and competent to carry out the tasks of the job. Staff confirmed that they had undertaken an in-house induction and foundation training to Skills for Care specification. There has been some slippage in the frequency of staff supervision. This is being addressed by the home by encouraging senior carers to undertake a supervisory role. The home has recently interviewed for several new senior posts and it is anticipated that this will include a deputising role in the absence of the Registered Manager. Residents were very complimentary about the qualities of the staff they made the following comments “friendly”, “attentive”, “caring” and “very willing and helpful” Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 21 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): Standard 31, 33, 35, 38 People who use the service experience good quality outcomes in this area. The resident’s benefit from living in a well managed home, where there is evidence that there health, welfare and safety is of importance. The registered person is qualified, competent and experienced to run the home for the benefit of residents This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Homes Manager - Jenny Poole is widely experienced and has attained the Registered Managers Award and NVQ 3 & 4 in care to further enhance her knowledge and skills. The manager is well supported by a team of carers. The current management structure appears to be sufficient to reflect the size and complexity of business currently undertaken. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 22 Staff said that the Homes Manager demonstrates effective leadership skills and is keen to support the staff teams personal and professional development. Staff confirm that they have the opportunity to express their opinions openly in staff meetings, supervision sessions and staff handovers. They say that they are provided with opportunity to express concerns, share information and to feel included and involved in the way the service is delivered. Residents were complimentary about the management of the home and feel that they are kept informed about what is going on. They say that the office is always open and accessible and the Manager makes time to speak with them on a daily basis. The minutes of residents meetings confirm that they have been consulted on a range of issues including what they would like to see in the garden following completion of the building works and what activities and entertainments they want in forthcoming months. The home asks residents and relatives to complete a quality assurance survey once a year. The outcomes are used to identify how best to develop the service in the future. Discussion took place about the outcome of Proprietors monthly monitoring visits (Regulation 26 reports). The Company Administrator has carried out these visits in past months but following discussions about legal responsibilities, the Proprietor has resolved to undertake all future visits personally and to report on his findings. The home does not hold any cash accounts for residents. All residents have a family friend or relative who manage their personal finances on their behalf. Examination of health & safety records indicated that they were up to date and in good order. Routine servicing and maintenance of equipment is undertaken at appropriate intervals to maintain the home as a safe and risk free environment for residents. All risks to residents are effectively risk assessed and managed. Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 23 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 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 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 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 24 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. 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. Refer to Standard Good Practice Recommendations Applegarth Care Home DS0000057355.V367040.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone 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 Applegarth Care Home DS0000057355.V367040.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. 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