Inspection on 01/02/07 for Ashley House

This inspection was carried out on 1st February 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

Ashley House 22/06/07

Ashley House 17/01/06

Ashley House 23/06/05

Ashley House 24/02/05

Ashley House 19/05/04

Ashley House 30/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashley House 155 Barlow Moor Road Didsbury Manchester M20 2YA Lead Inspector Judith Morton Unannounced Inspection 10:00 01 February 2007 st 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 Ashley House DS0000021531.V298742.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. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley House Address 155 Barlow Moor Road Didsbury Manchester M20 2YA 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) 0161 445 3776 Mrs Deborah Reynolds Ms Carmel McHale Mrs Deborah Reynolds Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (17), Physical disability (1) of places Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users accommodated is 18. That one named service user is accommodated who is under the age of 65. That the category of registration reverts solely to older people (OP) when this service user reaches the age of 65 or leaves the home. 17th January 2006 Date of last inspection Brief Description of the Service: Ashley House is a privately owned residential care home providing personal care and accommodation for 18 older people. The home is located in the Didsbury area of Manchester and is within easy reach of Manchester City Centre. The area is well served by public transport to the neighbouring areas of Stockport and Chorlton. In addition, the home is well positioned for local amenities such as shops, Didsbury shopping centre, hospitals and Manchester airport. The home is a large Victorian detached property that stands in its own grounds. Well-maintained gardens provide pleasant outdoor facilities. Parking is at the side of the building and there is access to a large car park to the side of the building. The accommodation comprises of twelve single and three double bedrooms. All rooms have a wash hand basin and are individually furnished with some residents bringing their own furniture into the home. There are two pleasant lounges on the ground floor and these were decorated to a satisfactory standard. A separate dining room is available where seating is arranged in small group setting of four. Accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. A lift is available to take residents to the first floor. On the day of the site visit the manager said that the weekly charges to residents living at Ashley House are, £358.09 for a shared bedroom and £373.54 for a single bedroom. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was carried out as part of the key inspection for the service. The inspection took place over 6 hours on 1st February 2007. A pre-inspection questionnaire and 13 residents questionnaires were also taken into account and comments from these are included within the report. During the visit time was spent talking with residents and the inspector joined three residents at their lunch. Three staff members and the owners/manager were also spoken with. Care files, health and safety records and a walk around the building also took place. Two of the residents showed the inspector their bedroom. What the service does well: What has improved since the last inspection? What they could do better: The manager should provide a training programme/schedule for all staff employed by the home. Formal, recorded supervision should be provided to all staff and should include their training needs/wishes. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 6 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. Ashley House DS0000021531.V298742.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 Ashley House DS0000021531.V298742.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): 1, 2, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. Good information about the service was provided and thorough assessments were done to make sure that residents’ needs can be met at the home EVIDENCE: There was a Statement of Purpose and Service User Guide available for the home. Some were made available in larger print, making it easier for residents with visual impairments to read. The content is good, and includes enough information to enable the residents to make a choice about whether their needs could be met at the home. All of the residents who returned their questionnaires said that either they or their family had been given this information when making a decision about whether to move into Ashley House. Four residents care files were checked. Each one contained a resident’s agreement, which included the charge for living at Ashley House. Each of the residents and/or a member of their family had signed this document. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 9 Each of the files had a detailed front sheet, which contained information about the resident, their family’s contact details, General practitioner details and reason for admission. However, the forms did not identify whether the resident wanted to follow their religion whilst living at the home. The manager should consider adding this question to the document. There was a pre-admission assessment document and on each of the files checked. This had been completed accurately, however, on two of the documents the answer to the question of hobbies and interests had been, ‘none’. It is unlikely that a person never had any hobbies or interests throughout their lives. The manager should consider asking the resident and/or their family to provide a detailed social history. This would reflect what the resident’s interests, hobbies, work and family life were like and activities or conversation can be arranged around this information. Residents’ health needs, any medication they were on and a medical history were recorded before they moved into the home. There was also a residents’ choice form which described the residents’ preferences, such as, what time to get up, where to have breakfast, what drink they preferred, what time they liked to go to bed etc. Residents’ spoken with and those who completed the questionnaires said that they had been to visit Ashley House for a look around, see their proposed bedroom and to meet the staff and residents before deciding on whether to move there. The manager said that prospective residents were able to talk with other residents once they have been shown around so that they can seek the residents’ views first hand. Ashley House DS0000021531.V298742.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, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The care plans and risk assessments were up to date and were being reviewed to make sure that residents’ needs continued to be met and they were not being left at risk. EVIDENCE: Each of the care files checked contained a care plan showing how residents’ needs should be met. The manager had carried out monthly reviews of the plans and checked that they were still appropriate. There were risk assessments in the residents’ files about falls, (particularly over the dogs also living in Ashley House), nutrition, bathing, moving and handling, and so on. The risk assessments had also been reviewed to show that the risk was still manageable. Residents’ weight was being recorded monthly, however, it was necessary for the inspector to read through all of the daily records to see that involvement from other professionals was being sought to meet specific needs such as health, chiropody, dental and optical. The manager should consider having one Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 11 form for recording the date, reason and outcome of visits from other health professionals. There was a record being made each day about how the resident had spent their day. There was nothing to show how the residents had felt about their day and the care they had been given. The entries being made by night staff did not show that regular checks on residents had been carried out and what support they might have needed during the night. It is recommended that steps be taken to improve this recording and to involve residents in commenting about their day so that there is full information about the care being provided to residents round the clock. Additionally, the frequency of checks needed for each resident should be risk assessed and recorded so that those who do not need/wish to be checked on hourly are left for a safe length of time. Medication sheets showed that medication was being recorded appropriately after administration. However, although four members of staff were responsible for administering medication none had received current medication training. The manager said that training had been identified, although it was not available immediately and the four staff would be first to go on it. Training must be provided to staff to enable them to fully and safely carry out their role. All of the residents spoken with were extremely complimentary about the staff. One resident said, “They are lovely, very patient”. Another resident said, “they are very kind, they will do anything for you. Residents spoken with said that staff always knock on their bedroom door before entering. One resident had written on their questionnaire that, “ I like the way the staff let you keep your privacy. I am a very private person. They are very kind and helpful and I am happy to call this home my home.” There was a record made on each of the files read stating what the residents’ wishes were on death and any arrangements that had been made if applicable. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 12 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, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The activities provided, together with the healthy balanced diet being received, ensure the continued physical and mental wellbeing of the residents. EVIDENCE: The residents spoken with said that there were activities for them but they did not always want to join in. One resident said, “They never force you to join in if you don’t want to”. There was an activities book, which was designed to show clearly the date and type of activity and whether or not the resident joined in. The activities offered were varied and included bingo, poetry reading, discussion groups, sing-along, music and dancing. Residents said they receive visitors regularly, this was reflected in their daily records. Some of the residents were taken on outings with their family members and those who can do so go out to the local pub/shops on their own. One resident spoke of getting the bus to the Trafford Centre, as the bus stop was only a little way from the home Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 13 Residents can make choices about their food, what they would like to wear, whether to join in activities, where to have their meals and how they wish to spend their time. Residents were seen to move around the home freely and spend time in their room if they wished. Residents said that the food at Ashley House is lovely. One said, “you get plenty of food here and it is always nice. Another said, “if you don’t feel like eating what was on offer they will make you something else, like a sandwich”. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 14 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 & 17 The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The complaints procedures and adult protection policies were robust so that residents could be confident their concerns would be listened to and they were protected from possible harm. EVIDENCE: The complaints procedure was available in the home and information about it was included in the Statement of Purpose and Service User Guide. There had not been any complaints made since the last inspection. None of the residents who were spoken with or who had returned their questionnaires had had cause to complain but had said they knew who to approach if they ever felt they had need to. One resident said the only problem had been the taxi arriving late for the resident to get to their morning session in the local community centre. They had spoken with the manager and this had now been resolved by using the ring and ride service. None of the staff have attended specific training on the Protection of Vulnerable Adults. However, those who had completed NVQ Level 2 and who spoke with the inspector confirmed that they had covered adult protection during this training. Policies and Procedures were available to guide staff in the event of them witnessing poor practice. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 15 The staff spoken with were able to demonstrate their awareness of what to do in the event of witnessing something that they recognised as a form of adult abuse. The manager should consider seeking adult protection awareness training for all staff, including any domestic staff, so that everyone can recognise when poor or abusive practice is taking place. Ashley House DS0000021531.V298742.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, 20, 21, 24, 25 & 26 The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. Ashley House is well maintained, providing a warm and comfortable home for the residents. EVIDENCE: The home continues to be well maintained, clean and comfortable for the residents. Residents live in safe, comfortable bedrooms and are able to have their possessions around them. All bedroom doors have locks but none of the residents choose to hold their key. One resident spoken with said, “ I could have a key if I wanted to but I don’t feel the need”. Two residents showed the inspector their bedroom. Each of the bedrooms were warm and comfortably furnished. One resident had purchased much of her own furniture and soft furnishings. Both residents had items around them that were important to them, these included, photographs, pictures and ornaments. There are two lounges, both with televisions and a dining room in which residents can choose to spend their day. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 17 Furnishings were domestic in character, appeared to be of good quality and were in keeping with the age of the property. All of the rooms occupied by residents have windows that can be opened for ventilation. The home is centrally heated and thermostatic valves are fitted to the radiators to allow individual control of temperatures in the rooms. All bedrooms radiators were low surface temperature. The manager maintains regular water temperature checks and a record of the checks made. There are three bathrooms and six toilets in various locations around the home on both floors. An assisted bath and hoists was available for those who need assistance with their personal care. The grounds surrounding the property were tidy and well maintained and access to the garden was via a ramp, providing additional communal space for residents in the better weather. There were two cats and three dogs living at Ashley House. All of the residents spoken with said they loved having the animals present, one resident said, “ if I don’t give Sweep his strokes first thing in the morning he doesn’t talk to me all day”. It was clear from this that the residents enjoyed the company of having pets. There were no offensive smells in any area of the home on the day of visit. Ashley House DS0000021531.V298742.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, 28, 29 & 30 The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The provision of appropriate training together with the thorough recruitment checks being made, adds to the assurance that the residents are in safe hands at all times. EVIDENCE: The staff rotas provided with the pre-inspection questionnaire showed that there was sufficient staffing available to meet the needs of the residents. The staff spoken with confirmed that this was the case. One member of staff said that there were always three carers on duty in the morning, in addition to the two owners/manager and two carers in the afternoon/evening. There was one waking night staff and the owner/manager lived in the flat upstairs and acted as the sleep in member of staff. One member of staff said that because they were a small staff team they would cover for each other if a member of staff was off ill or on holiday. They received their allocated holiday leave and time off duty. The induction programme for new staff included training in health and safety, fire safety, moving and handling and Ashley House care policies and procedures. The manager supervises the progress of staff and the staff and manager sign the induction record at the end of the programme. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 19 Four staff files were checked during the visit. They showed that the recruitment procedure for the home had been followed thoroughly. A criminal record check had been made both with the foreign authorities and the Criminal Record Bureau in England, in respect of a foreign member of staff. This is good practice. Additional training in moving and handling, use of a hoist and slings etc had also been provided to staff. Four of the staff hold National Vocational Qualifications in care Level 2 (NVQ 2) and a further member of staff was due to complete the NVQ 2 within a few weeks. One member of staff has been enrolled onto NVQ Level 3 but this was not due to start for some time. It was necessary for the inspector to read through each of the staff files to establish what training had been received and when refresher training was due. The manager should consider producing a training matrix to show what training each member of staff has had and when. This will make it easier for her to see when refresher training is due for individual staff members. Ashley House DS0000021531.V298742.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The home provides a service that has the procedures and systems in place to promote the interests, safety and well being of residents in the home. EVIDENCE: The residents were fully aware of who the manager was and were seen to freely interact with her during the site visit. The staff were also observed to interact well and those spoken with said they found her approachable. One member of staff who had worked at Ashley House for some time said, “I have worked in other homes before this and the manager/owners here are by far the best people I have worked for”. Residents spoken with were extremely complimentary of all of the staff at Ashley House. “The staff are lovely, very caring and can’t do enough for you”. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 21 There was no evidence of Residents’ meetings being held and no other method of quality assurance was carried out, ie surveys of residents, relatives, staff and other professionals who are involved with the home. The manager should consider ways of giving residents, and others, opportunities to voice their opinions and share any ideas for improvements in the service they receive at Ashley House. The home does not manage any of the residents’ accounts. One resident was able to manage their own financial affairs and other residents’ families help them with financial affairs, where necessary. Emergency lighting is provided throughout the home. There is a policy to deal with infection control and a copy is kept in the policy and procedures manual. The manager has conducted a general fire risk assessment of all areas of the home, together with individual risk assessments of each of the resident’s rooms and the resident’s knowledge of what to do in the event of a fire. The manager said that staff are directed to read this information and the addition of fire drills reinforces this with both staff and residents. The manager was regularly taking and recording the temperatures of the hot water systems provided throughout the home. Ashley House DS0000021531.V298742.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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 3 3 3 X X 3 3 3 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 X X 3 Ashley House DS0000021531.V298742.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 OP9 Regulation 12, 16 Requirement Medication training must be provided to staff to enable them to fully and safely carry out their role. Timescale for action 01/07/07 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 OP3 Good Practice Recommendations The manager should consider adding further information to the assessment as follows: • A brief life history of the resident • Information about the resident’s religious practice, The manager should take steps to make sure: • Residents’ views of the care they have received are included in the daily records. • The night staff record the checks they have carried out and the support they have given. • Risk assessments should be carried out and residents’ views should be sought to determine the frequency of night time checks. The manager should consider having a form for recording DS0000021531.V298742.R01.S.doc Version 5.2 Page 24 2 OP7 3 OP8 Ashley House 4 OP18 5 OP30 6 OP33 the date, reason and outcome of visits from other health professionals. The manager should consider seeking adult protection awareness training for all staff, including any domestic staff, so that everyone can recognise when poor or abusive practice is taking place. The manager should consider producing a training matrix to show what training each member of staff has had and when. This will make it easier for her to see when refresher training is due for individual staff members. The manager should consider ways of giving residents, and others, opportunities to voice their opinions and share any ideas for improvements in the service they receive at Ashley House. Ashley House DS0000021531.V298742.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Ashley House DS0000021531.V298742.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!