Inspection on 24/10/05 for Ashtead House

This inspection was carried out on 24th October 2005.

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

Ashtead House 11/07/07

Ashtead House 05/12/06

Ashtead House 06/06/05

Ashtead House 14/12/04

Ashtead House 20/09/04

Ashtead House 16/02/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Ashtead House Ashtead House 153 Barnett Wood Lane Ashtead Surrey KT21 2LR Lead Inspector Suzanne Magnier Announced Inspection 24th October 2005 10:00 Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 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 Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashtead House Address Ashtead House 153 Barnett Wood Lane Ashtead Surrey KT21 2LR 01372 810330 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) www.alliedcareltd@aol.com Ashtead House Ltd Miss Sheila Cassidy Care Home 10 Category(ies) of Learning disability (6), Physical disability (4) registration, with number of places Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be 18 - 60 YEARS. 6th June 2005 Date of last inspection Brief Description of the Service: Ashtead House is a detached property set in its own grounds a short distance from local shops of Ashtead town centre. Accommodation is provided in single occupancy rooms which comprise of five on each of the ground and first floor. There are communal areas which comprise of a kitchen, a spacious lounge/dining room and a bedroom which has been converted to q quiet room where residents can use the computer. There is no lift to access the upper floor. There is a large communal garden at the rear and parking for several cars at the front of the building. The home is registered to provide care and accomodation to ten people with mild to moderate learning and physical disabilities. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Announced inspection took place over 6 hours. The inspection was conducted with the Registered Manager. For the purpose of the report the Registered Manager advised the inspector that the people who live in the home are referred to as residents. The home supports people who have varying needs and communication methods, which could be viewed as challenging, and need specific understanding of their individual needs. Part of the focus of the inspection was to review, with the Registered Manager requirements made under the Care Homes Regulations (as amended) 2001 at the last inspection and assess the remaining standards. During this time person centred plans care plans, risk assessments and several policies were sampled. The inspector met with the majority of residents and a full tour of the premises was undertaken The inspectors wish to thank the residents, staff and Registered Manager for their cooperation during the inspection. What the service does well: With the commitment and enthusiasm of the Registered Manager and staff the resident’s best interests are promoted. Comments from the homes recent Quality Assurance audit included ‘ the service and the care are excellent’; ‘I have made friends with everyone I like living here’; ‘I found the home to be cheerful and friendly with a relaxed atmosphere’. The home has updated the Statement of Purpose and the Service Users Guide using photographs and clear guidance to ensure that prospective residents and their representatives are fully informed of the services and facilities offered by the home. Through the documentation sampled, the inspector concluded that the home has strong professional links with a variety of health care professionals in order to promote the safety and wellbeing of the residents. In discussion with the Registered Manager and through direct observation the inspector noted that staff showed insight in understanding challenging behaviour and ways in which the person can be supported in making sure they are understood. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 6 The inspector noted that the staff have had ongoing and current training in skilfully (within agreed documented guidelines and inclusion of a variety of health care professionals) of diffusing behaviours of residents when they are distressed in a dignified and professional manner thus meeting the residents immediate need and reduce the anxiety of the situation. The inspector sampled some ABC (antecedent, behaviour, consequence) charts, which the home uses to establish patterns and gain understanding of what a person is communicating through behaviour. The home generates a sense of each person’s individuality and promotes resident’s independence and inclusion within the local community and in their home. With the commitment and enthusiasm of the Registered Manager and staff the resident’s best interests are promoted. The home has conducted Quality Assurance Audits, and ensures that staff development is maintained. What has improved since the last inspection? What they could do better: The complaints procedure needs to be updated to include clear guidance that a complainant can inform CSCI of any complaint. Two requirements have been made regarding health and safety. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5. The home provides proposed residents with adequate information prior to their stay. Documentation related to the residents tenancy arrangements and agreements have been implemented following the previous inspection. EVIDENCE: The inspector sampled the Statement of Purpose and Service User Guide, which are written, use quotes from residents and contain photographs of the home, the facilities within the home and also areas and places of interest within the local community. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8 10. The home has made a concerted effort to improve the care plan and risk assessment documentation and implement a person centred plan (Lifestyle plan) for each resident. The home has professional links with a variety health care professionals, which was evident through the documentation sampled and ensuring that care plan reviews are held in order to promote the wellbeing of residents. EVIDENCE: The inspector sampled one person centred plan, which the resident, Registered Manager and staff had spent a concerted amount of time developing. The plans included clear descriptions of the resident’s life, ways of communicating, including behaviour, their needs and aspirations. The Registered Manager and staff have developed comprehensive risk assessments, which support the resident’s care plan to ensure that their safety is promoted. The inspector sampled some ABC (antecedent, behaviour, consequence) charts, which the home uses to establish patterns and gain understanding of what a person is communicating through behaviour. This was viewed as good positive practice and showed insight into the staffs Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 11 understanding of challenging behaviour and ways in which the person can be supported in making sure they are understood. Through the homes reporting of Regulation 37 notifications the inspector was aware that specific agreed working guidelines, for the use of mild physical restraint had been documented to support one resident who needed additional support on occasion. The guidelines had been agreed with various health care professionals to support the person to ensure their safety and others. The inspector was informed that ongoing support and training from an external organisation had been recently updated and the records indicated that the resident and staff members were able to diffuse the challenges in a dignified and professional manner thus meeting the residents immediate need and reduce the anxiety of the situation. It was noted that the staff promoted the residents rights to take an active role in the running of their home. There was a genuine ‘banter’ by some residents that included fun and a sense of individuality. It was evident that staff took and active role in encouraging and promoting inclusion of residents in all aspects of the home. The inspector noted that the files and related documentation for residents were individually stored in their own files, which were kept in a filing cabinet in the locked main office. Within the resident’s tenancy agreement the inspector note a paragraph regarding confidentiality. A recommendation has been made that the home considers developing a specific document to advice residents of their rights to confidentiality and access to their records. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16. The home generates a sense of each person’s individuality and promotes resident’s independence and inclusion within the local community. EVIDENCE: The inspector met with several residents throughout the course of the day. Several residents told the inspector about their plans for the day, which included going to work, meeting with friends, going to the cinema, shopping or staying at home and ‘pottering’ about. One resident and the inspector talked at length about the ‘X Factor’ on TV and the inspector was told ‘I like living here’. It was noted that the resident had got up late and was enjoying being at home watching T.V. before attending a dental appointment in the afternoon. Comments from the recent quality audit carried out by the home included ‘ my parents visit me at least once a week’; ‘staff take me to church every Sunday morning’; ‘I am normally asked what I want to eat’. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 13 CSCI comment cards received from some residents included what’s good about the home ‘ very helpful staff’ ‘transport’ ‘the quiet room’ ‘the shower’ and ‘I can do what I like’. Comments, which reflected what residents thought, were not so good included ‘cars speeding on the busy road’ ‘sometimes I don’t feel well cared for and staff don’t listen’. A resident told the inspector that they had recently purchased their own motor scooter. They told the Registered Manager that they wouldn’t be riding it to work as the weather was too wet and windy and it wouldn’t be safe. During the inspection the inspector noted that a counsellor was supporting one resident privately and staff were available for the residents who were at home. The inspector observed that people were free to move around the home and one resident enjoyed having a cigarette in the designated area. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19. It was positive and encouraging to note that staff promoted the rights and needs of individuals in their home. EVIDENCE: During the course of the inspection it was encouraging to note that the residents were being encouraged to have control over their lives. For example being free to move around the house and also be supported to express themselves freely. Other examples indicated that staff had taken time to reflect upon their practice regarding people’s lifestyle and routines. The staff demonstrated awareness of the routines in the home, which indicated that the service was person centred and individualised. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. The complaints procedure needs to be updated to include clear guidance that a complainant can inform CSCI of any complaint. EVIDENCE: The inspector sampled the homes complaints procedure and noted that the procedure did not clearly include detail that a complainant can contact CSCI if they choose to. A requirement has been made that the complaints procedure is amended to include this information. The documents sampled to support residents who engage in self-harm and the protection of others was in place and skilfully managed in the home with the support of a variety of health care professionals and specialised training including the Protection of Vulnerable Adults. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30. The Registered Manager and staff have made a concerted effort to continue to improve the general environment of the home for the benefit of the resident’s. Several areas within the home have been made more accessible and tastefully redecorated. A recommendation has been made that a shower curtain is installed to further promote the dignity and privacy of resident in the shower. EVIDENCE: The house was noted to be clean and hygiene standards maintained. Several areas of the home have been redecorated which included the showers, lounge and dining room ceilings and the hallway and landing redecorated. New kitchen cupboards had bee purchased and the kitchen redecorated. The general ambience of the home was observed to be calm and homely with ornaments framed pictures and comfortable sofas, armchairs and space for residents to move around freely in wheelchairs. One comment card received included ‘The home has a clean and pleasant relaxed atmosphere’. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 17 The Dining/Lounge room area has been favourably redecorated and the dining suite consisting of solid wood chairs and tables were viewed as suitable for the needs of the residents. The lounge was also equipped with a television for the use of all people in the home. The kitchen was clean and orderly. Fire safety equipment was noted to be available and residents were enabled to use the kitchen facility with staff support. The inspector sampled the fridge freezer temperatures, which were recorded appropriately. The fridges and kitchen were well stocked with fresh fruit and vegetables. During the tour of the premises the inspector was invited by some residents to see their rooms. One resident told the inspector that their room met all the health and safety requirements and that they enjoyed having a double bed. A comment card received from a resident stated ‘I like my room I chose the colour of my room’. Within some of the bedrooms residents had their own personal possessions including photos, ornaments, music centres and C.D’s. There was evidence of hobbies and certificates of achievements. One bedroom viewed by the inspector included a specialised profile bed, and Oxford hoist, which had been recently serviced. The home has employed a maintenance person who has, with the Registered Manager and staff implemented a maintenance plan, which incorporates a monthly health and safety check and also planned decoration and repairs in the home. The home has a bathroom and walk in shower that is used by residents. A recommendation has been made that a shower curtain is installed to further promote the dignity and privacy of resident in the shower. The shower room had recently been redecorated with the residents having choice in the tiles and colour of the room. The laundry has been equipped with a washing machine and adequate fire prevention equipment was in place. It was noted that washing powder tablets had been left out and the Registered Manager explained that this had been risk assessed as not a hazard currently identified. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36. The staff team have clear roles and responsibilities and are supported to undertake their tasks and receive appropriate levels of support. EVIDENCE: Throughout the inspection the inspector noted a genuine professional conduct between the staff and residents. It was evident through speaking with residents that they were aware of the roles and responsibilities of the staff team and also the names of their key workers. Comment cards received from relatives and friends of the residents included ‘I would like to thank the staff for their help and understanding’; ‘Like to express my gratitude on the work you and the team have made’. The inspector sampled staff recruitment records and noted that no staff had been recruited since the last inspection. Staff support and supervision records were current, which indicated that the homes Registered Manager monitors staff performance. The staff training development plan was evidenced to include details that staff had undertaken statutory training and also had been included to undertake specialised training including understanding and awareness of Aspergers Syndrome, Autism, Epilepsy and Challenging Behaviour training. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 19 Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): With the commitment and enthusiasm of the Registered Manager and staff the resident’s best interests are promoted. The home has conducted Quality Assurance Audits, reviewed the policies and procedures and ensures that staff development is maintained. Two requirements have been made regarding health and safety. EVIDENCE: Comment cards received from relatives and friends of the residents included ‘the home is managed to a high standard’; ‘the management of the home is run efficiently and effectively’; the management and staff are exceptional’; the freedom and security provided has enabled…..to be relaxed and contented’. There was clear evidence that the general morale of the staff within the home was good. The Registered Manager advised the inspector that there is consideration of designating a particular area of the home to a staff member for example the kitchen, fire, and health and safety. This would also serve to assist staff in gaining valuable experience with their NVQ achievements. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 21 One resident told the inspector ‘when I hear the fire alarm I go outside’. The inspector has made requirement that the door opposite the staff sleepover room has a fire notice attached to clearly illustrate to all persons in the home that the door is a fire exit. The inspector noted that the waste bin in the laundry area did not have a lid and a requirement has been made that the Registered Person must make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the care home and a bin lid must be provided. The home has undertaken a quality assurance audit, which has involved residents and their representatives and some of the responses have been included in the report. The Registered Manager advised the inspector that Allied Care have recruited a Quality Assurance consultant who has arranged to visit the home to conduct a full audit of the home. The home is currently reviewing all the policies and procedures and new policies and procedures produced by Allied Care are being implemented in order to ensure the efficiency and effective operation of the home. The Registered Manager has achieved the City and Guilds Advanced Management for Care and also has an NVQ Level 3 and the Assessors Award. The inspector was advised that all staff are currently undertaking the NVQ Level 2 or 3 award with 2 staff having completed the award. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x 3 Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x 3 x 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 2 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashtead House Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 x DS0000013561.V263938.R01.S.doc Version 5.0 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 22 Regulation 22.(7) (a)(b) Requirement The Registered Person must ensure that the homes complaints procedure is amended to include CSCI details in order that a complainant is aware a complaint can be addressed with the CSCI. The Registered Person must ensure that means of escape form fire are clearly defined for example the door opposite the staff sleepover room has a fire notice attached to clearly illustrate to all persons in the home that the door is a fire exit. The Registered Person must make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the care home and ensure that the waste bin in the laundry area if fitted with a lid. Timescale for action 14/11/05 2 42 23.(4) (b)(c)(iii) 14/11/05 2 42 13.(2) (k) 14/11/05 Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 10 27 Good Practice Recommendations The home, consider developing a specific document to advice residents of their rights to confidentiality and access to their records. The home, consider purchasing and installing a shower curtain to further promote the dignity and privacy of resident in the shower. Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Ashtead House DS0000013561.V263938.R01.S.doc Version 5.0 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. 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