Inspection on 01/08/05 for Ashurst House

This inspection was carried out on 1st August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashurst House 04/11/08

Ashurst House 07/11/06

Ashurst House 02/05/06

Ashurst House 24/06/05

Ashurst House 04/02/05

Ashurst House 07/09/04

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

CARE HOME ADULTS 18-65 Ashurst House 9 Briton Road Faversham Kent ME13 8QH Lead Inspector Kim Rogers Unannounced 01/08/05 at 11:00 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 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 Stationary 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. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashurst House Address 9 Briton Road, Faversham, Kent, ME13 8QH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01795 590022 Ashurst House Limited Mrs Rachel Harris Registered Care Home 8 Category(ies) of Learning Disabilities registration, with number of places Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: This home is registered to support adults between 18 and 65 years who have a learning disability. Date of last inspection 24/06/05 and 8/07/05 Brief Description of the Service: Ashurst house is a large detached property in a residential road of Faversham. The property has been converted for its present use. The home is owned and run by the company Allied Care Ltd who are based in Surrey. The home is registered to provide personal care and support to up to eight adults aged 1865 years who have a learning disability. There are currently six Service Users living at the home whose age range is about 30-46 years.Accommodation is set over two floors. Stairs access the first floor. All rooms are for single occupancy and have en suite toilet facilities. Some rooms have en suite bathrooms and showers. All bedrooms are fitted with locks and have a television aerial point. There is a large lounge, separate dining room and kitchen. There is a second small lounge on the first floor. There is a small garden to the rear of the property. There is limited parking to the side of the property.The home is within walking distance of the railway station and bus stops. Local shops and facilities can be easily accessed. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out by Kim Rogers from 11.00 to 16.00 on a Monday. The purpose of this visit was to check the progress made towards meeting outstanding requirements made at inspections on 4/2/05 and 24/6/05. Following the visit of 24/6/05 an adult protection alert was raised. Kim Rogers and Yvonne Phillips, the Adult Protection Coordinator for Swale made a joint unannounced visit to the home on 8/07/05. The findings of this additional visit are held at the area office for viewing on request. Findings from additional visits are not available on the CSCI website. The subsequent investigation regarding the adult protection alert is ongoing. The Inspector looked at areas under investigation during this visit and will report back to the adult protection panel. The main areas looked at included, The use of physical interventions by staff Care planning Risk assessments Behaviour management guidelines Recording and reporting of incidents Staff competency and training. Only National Minimum Standards relating to the above areas were assessed. Please see previous reports for how the home performs against other standards not assessed here. John Connock, area manager of Allied Care has carried out an internal investigation following the last inspection. This investigation was carried out because of some serious incidents at this home. One member of staff has been suspended and others may face disciplinary action. The Inspector was joined at 13.40 on 1/8/05 by Christine Hastie, Pharmacy Inspector who looked at all areas of medication practice at this home. The Pharmacy Inspector assessed the outstanding requirements made regarding medication practices at the visit on 4/02/05. Medication practices at this home are poor, which places service users at risk. Requirements of 4/02/05 remain unmet. A number of requirements were made to address this. The Inspectors spoke to staff and service users. A team leader, Graham Lane was on duty. The manager was ‘working from home as there was no management support for her today’ Since the first adult protection meeting of 11/07/05 Allied Care have provided management support for Rachel Harris. The manager, Rachel Harris arrived at the home at 12.45pm. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 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 standard(s) 2 The assessment process at this home has been improved. Prospective service users know their needs will be assessed. EVIDENCE: The Inspector sampled service user plans. The manager said that 3/6 service plans have been updated since the last visit. The Inspector looked at one service user plan in detail. The plan contained a detailed assessment carried out by the home. The assessment seen was dated 18/7/05. The manager had signed the assessment. No service user or their representative had signed. The assessment is recognised by the standards as crucial as the assessment forms the basis of the service user plan. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 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 standard(s) 6,9 Some care planning and risk assessments have been improved however service users cannot be sure their changing needs will be identified and supported. EVIDENCE: The service user plan is the agreement between the home and the service user about how the home will meet that persons needs. The manager said that 3/6 service plans have been reviewed and updated since the last visit. The Inspector sampled one service use plan in detail. The care planning process at this home has been overhauled and improved. Plans have been rewritten with much more detail. Significant life changing events are now included in service user plans. Behavioural management guidelines seen in one plan were clear and more detailed. Distraction and diffusion techniques for staff to use are recorded. The guidelines stated that Securi-care physical intervention would be used as a last resort. If this is the case the Inspector required that the guidelines state clearly that after any physical intervention by staff medical advice is sought for Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 11 service users. Any use of restraint or intervention must be reported to the CSCI. Risk assessments are included which have been improved to cover all areas of potential risks. The Inspector noted that most areas of the care plans and risk assessments recorded ‘review six monthly’. Service users needs may fluctuate, may be stable or change regularly. The Inspector required that all service user plans are reviewed at least monthly so changes in needs can be identified and recorded and the correct support put in place. One service user has been assessed as requiring one to one support from staff. The Inspector observed the member of staff providing this one to one support by following the service user around the home. On two occasions the service user shouted ‘stop following me’ to this member of staff. The service user appeared to be getting angry about this close supervision. The team leader confirmed that the service user ‘is independent and likes his own space’ This support must be reviewed to ensure it is effective and meeting the service users needs. Records continue to be stored on open shelving in the duty office. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 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 standard(s) 15 Service users know their relationships with their friends and family will be supported. EVIDENCE: Service user plans now contain relevant information about service users friends and families. Life changing events in a person’s life are now recorded. Relationships, which can cause some conflict, are now detailed. The Inspector noted that there was no evidence of relatives or representatives being involved in assessments or care planning. Please see the report of 24/06/05 for the performance of this home against the other standards listed above. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18,20 Service users know that the way they prefer to be supported with their personal care will be recorded. A review of medication handling was undertaken by a CSCI pharmacist inspector who concluded that there was a lack of safe systems in place for medicine handling and administration and that this could potentially place service users at risk. EVIDENCE: Personal care needs are now more detailed. This ensures that staff are aware of how a person prefers to be supported. Although the home has several corporate policies, it had no actual procedures in place to direct staff in medicine handling in the home. Self-administration was not currently taking place but there was no provision for a lockable facility should a service user wish to do so. There were some records of receipt, administration and disposal but they were incomplete so that an audit trail was not possible. The records did not sufficiently demonstrate that medicine was being given as prescribed. The record of current medication was not kept up to date. The home was not following the Royal Pharmaceutical guidelines for storage and the system in place for transporting medicine to service users was unsafe. Unwanted and discontinued medicine was still present in current medication trays and out of date medicine was found to be present. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 14 There was no provision for cold storage and the provision for storing Controlled Drugs (CDs) and keeping a register did not meet the Regulations. Medicines provided for weekend leave were prepared by staff. Staff training has taken place but no assessment for competency has taken place. Training for administration requiring special techniques was not individualised to the service user and care plans seen lacked clarity. There appeared to be no monitoring or audit of medication practices by the registered manager. The manager was unaware of the outdated stocks that needed to be returned. The manager and team leader were not aware of basic management of medicines when asked. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 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 standard(s) 23 Service users are currently protected from abuse. EVIDENCE: Following the adult protection alert staff have been instructed by the investigation panel to stop all forms of physical intervention. A service user told the Inspector they were happier because of this decision. No physical intervention or restraint has been used since 11/7/05. Staff have been instructed that if an incident requires restraint to be used the police are to be called. The staff have not needed to call the police to any incident. One staff has been suspended since the last inspection and the area manager may discipline more stay following his investigation. Adult protection training has been planned for 16/8/05 and 24/8/05 the number of places is unclear. The manager said ‘as many staff as possible ‘will attend. Guidelines about supporting service users who may be aggressive or self-harm are more detailed. As mentioned more regular review is needed. Incidents and accidents have been reported to the manager and area manager since the last visit. Incidents have also been reported to the Commission. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 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 standard(s) 24 The home has a more homely feel. EVIDENCE: Staff said they have made an effort to make the home, especially the large lounge, feel more homely. Some furniture has been moved and pictures put up. The lounge has a more homelike feel. Please see the last report for a detailed assessment of the other standards listed above. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 Staffing is not currently effective and must be reviewed. Staff are aware of their roles and responsibilities. EVIDENCE: Some service users have been assessed as needing one to one support from staff. This must be kept under close review by the home, as it was evidently not meeting some service users needs. Staff were following service users around the home. One service user appeared angry about this very close supervision. Some incidents have been reported when 2 service users funded on a one to one basis have been involved in an incident with a third service user, also on one to one being the only witness. Staff deployment must be effective and must suit the needs of the service users. Staff were aware of most of the concerns about this home and said they have been working with the manager and management support to address the issues. Staff could say whom they should report incidents to and said they always use the on call system to report immediately to the manager. Some training has been arranged including adult protection, secure care physical intervention and first aid. Staff were unable to answer basic questions about medication. The Inspector noted that medication training is planned for 23/08/05. The Inspectors noted that all certificates in staff files were copies. The manager said that this was Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 18 company policy. The Inspectors required that all certificates in staff files be the originals. Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,43 Recent intensive management support has ensured that this is a better run home. Monitoring and audit by management must improve if service users are to be fully protected. EVIDENCE: Allied care ltd have provided extra support for the manager including daily support from area managers and managers of other Allied care homes. It was evident that care plans and risk assessments have been overhauled, rewritten and improved. These improvements will only be effective if service user plans and risk assessments are kept under close review and their effectiveness monitored by the manager. The manager was unaware of poor medication practices. The manager or the area manager had not identified shortfalls against national minimum standards during his monthly visits to the home. Staff were asked if they has attended a staff meeting since the last inspection. They said ‘ I think one is planned’ Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 20 Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 21 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 x 3 x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x x x x 3 x x Standard No 31 32 33 34 35 36 Score 3 x 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashurst House Score 3 x 1 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x x 2 H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 22 YES Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13(2) Requirement The home has procedures covering all aspects of medicine management and these are signed and dated There are clear, accurate records of all medicines received, administered and leaving the home There is an up to date list of current medication for each service user The home reviews the storage and transport of medicines and improves this in line with advice given Medicine for internal use is stored separately to medicine for external use, medicine is kept clean and tidy and checked regularly for expiry dates, limited life medicine is dated The home follows the Royal Pharmaceutical Society’s guidelines in the supply of medicine for leave All medicine administration is arranged to avoid any interruption All staff handling and administering medicine are competent to do so Timescale for action 30/11/05 2. YA20 13(2) 31/08/05 3. 4. YA20 YA20 13(2) 13(2) 31/08/05 31/10/05 5. YA20 13(2) 15/09/05 6. YA20 13(2) 31/10/05 7. 8. YA20 YA20 13(2) 18c (i) 15/09/05 30/11/05 Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 23 9. YA1 5 10. YA5 5 11. YA23 13(7) 12. YA20 13(2) 13. YA42 12 14. YA34 19 15. 16. YA33 YA6 19(5) 15 The Registered Person must produce a suitably detailed Service User Guide. A copy should be given to Service Users and a copy sent to the Commission.NOT INSPECTED The Registered Person must develop an individual contract of terms and conditions of residency with each Service User.NOT INSPECTED The Registered Person must ensure that behavioural support guidelines are in place where necessary based on current good practice. Guidelines should be authorised and agreed with the Service User.Staff must be competent when using any physical intervention techniques.Guidelines must be regularly reviewed. NOT MET The Registered Person must ensure that Service Users control and administer their own medication within a risk management strategy.Service Users consent to medication must be recorded.NOT MET. Competency appraisals for all staff relating to fire safety must be carried out.All fire equipment at the home must be checked at suitable intervals.NOT INSPECTED The Registered Person must audit staff files to ensure all documents required under Schedule 2 of the Care Homes Regulations are obtained in respect of each member of staff.NOT INSPECTED Staff must have the suitable skills for the job including communication skills. NOT MET. All Service users must have a detailed service user plan which is regualrly reviewed.NOT MET 30/03/05 30/03/05 30/06/05 Immediate 30/03/05 30/05/05 30/05/05 30/05/05 30/06/05 Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 24 17. YA9 13(4) 18. YA33 18 All potential risks to Service users must be assessed and where possible eliminated. Risk assessments must be regularly reviewed.NOT MET The registered person must ensure that staff are competent to do the job.NOT MET 30/06/05 30/06/05 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. 3. 4. 5. Refer to Standard YA20.6 YA20.8 YA20.11 YA20.10 YA10 YA29 Good Practice Recommendations The home has a lockable drug fridge The home has a metal cupboard complying with the Misuse of Drugs (Safe Custody) Regulations 1973 and a register for record keeping The home has a British National Formulary (BNF) as a source of reference All information and records relating to Servce users should be held securely. NOT MET Staff and Service Users should be involved in the review and development of policies and procedures, which should be produced in formats suitable for Service Users.NOT INSPECTED The Registered Person must ensure that the refrigerator is maintained at the correct safe temperature for food storage.NOT INSPECTED The home should provide separate premises including communal day space, facilities and equipment for Service Users on respite or short stay unless benefits for both groups can be demonstrated. NOT MET The Registered Person should help Service Users, if they wish, to participate in local independent advocacy/ selfadvocacy groups and /or to find peer support from someone who shares the person’s disability, heritage or aspirations.NOT MET 50 of care staff should be qualified to at least NVQ level 2 by 2005.NOT MET Service users and their representatives should be included in care planning and assessments. 6. 7. YA42 YA24 8. YA7 9. 10. YA32 YA6 Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent, TN23 1HU 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 Ashurst House H56-H05 S57495 Ashurst Hosue V241596 FUV 010805 Stage 4.doc Version 1.40 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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