Inspection on 22/01/08 for Ashwood House

This inspection was carried out on 22nd January 2008.

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

The inspector 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashwood House 29/08/06

Ashwood House 17/01/06

Ashwood House 12/07/05

Ashwood House 11/01/05

Ashwood House 13/07/04

Ashwood House 09/01/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Ashwood House 51 Foxhill Norwood London SE19 2XE Lead Inspector Ann Wiseman Key Unannounced Inspection 22nd January 2008 10:30 Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 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 Ashwood House DS0000006880.V357391.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 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. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood House Address 51 Foxhill Norwood London SE19 2XE 020 8771 7742 020 8771 7742 ashwood@beaconcaregroup.co.uk 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) Beacon Care Ltd vacant post Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 12 29th August 2006 Date of last inspection Brief Description of the Service: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Ashwood House is a large detached three/four storey converted house set in a residential area of Upper Norwood. Beacon Care owns the property. The home is located within a short walking distance of Upper Norwood town centre and Crystal Palace Park and therefore has excellent bus and rail links. The home is registered to care for twelve younger adults with learning disabilities, three of whom are registered as wheelchair users. The premises are accessed externally by a ramp that leads from the side of the front of the house. People have access to a small garden at the rear of the property. The communal areas, bathrooms and toilets are easily accessible and there is a lift to access the other floors of the house. Fees are £920 a week. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and we spent six hours in the house when we talked to the manager, staff on duty and some of the people living in the home. There have been several changes of manager recently, two since the last registered manager resigned. The latest manager has only worked in the house for four months and is yet to apply for registration, she intends to very soon. The manager had already sent us the Annual Quality Assurance Assessment (AQAA) he had completed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. We used the information given in it during this inspection. We have sent surveys to the people living in the house and to their relatives and we have had thirteen returned and they mainly said that the quality of care given in this home was good. 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 6 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 Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 7 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2 and 5 were assessed on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People considering moving in are given enough information so they can make an informed choice about the home and are given contracts once they do. Their needs and aspirations are assessed before they move in. EVIDENCE: The home has a statement of purpose and guide that are written in an easy to read style with pictures. A guide is given to everyone who moves in and it includes a summery of the statement of purpose and the homes complaints policy. Copies were seen in the people’s files that were examined during this inspection. Contracts were also in the files, they outlined fees, people’s responsibilities and any additional charges that may apply. Fees varied between £920 and £822 a week. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7, 9 and 10 have been judged during this inspection. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their changing needs and personal goals are reflected in their care plan. People are able to make decisions about the way they live their lives and are able to take risks as part of an independent lifestyle. Personal information is stored in a locked filing cabinet. EVIDENCE: We examined three different people’s files and saw that care plans have been developed in a style that was person centred. Information was gathered from as many different sources as possible including the person themselves, previous care homes, day centres, professional involved, friends and relatives. The information gathered was formed into comprehensive care plans that where outcome focused. Reviews are held regularly and goals are set which are monitored until they are completed. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 9 Risk assessments were on file that had been carried out to identify areas of possible danger in people’s lives. Strategies were developed that minimized risk but allowed people to live a full and active life. Personal information about people living in the home is kept in a locked filing cabinet in the office. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 were assessed during this visit. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in this home have opportunities to take part in activities in the home and local community and they have maintained contact with friends and family. People’s rights are respected and they are offered a healthy and varied diet. EVIDENCE: This home employs a full time driver to be available to use the house minibus to take people to and from their daytime activities and any other appointments that arise. This means that people are able to get out into the community for shopping, eating out and trips to the pictures etc. Some of these activities were set as goal in people’s reviews and activities were recorded in the daily recording sheets. When we talked to some of the people who live in this home they talked about going shopping and a visit to the hairdresser. They also told us about the Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 11 holiday some of the people had last year, the weather was wet and cold. This year they were hoping to go somewhere warmer. People also said that the staff were nice to them and asked them what they wanted to do and did not make them go out if they didn’t want to. One person said they wished the home would get a bigger television, they had discussed their idea with staff. They had listened to him but have said that they may be getting a better TV soon, but that the one he wanted was too expensive. The menus showed that the meals provided were varied and that alternative meals were offered. Dinner was being cooked while we were at the home and smelt appetising. We asked people what they thought of the food and three said it was lovely and another said it was “all right” The dinning room has Formica tables that are chipped and marked and the chairs are mismatched. The room is in need of decorating and is outdated and worn. This is one of the rooms that will be redecorated and refurnished while people are relocated to another house. A lot of work needs be carried out to the house including a new roof so it will all be done at the same time. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 were examined on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People are supported in the way they prefer and their health needs are met. Medication policies and procedures are in place but some work needs to be done on improving practice. EVIDENCE: Care plans record how people prefer to receive support. We spoke to staff that said that they had read the care plans and were involved with their review. They also said that they ask people if they wanted help and gave them choices whenever they could. Two said they had attended training sessions about person centred planning and that supporting people with personal care was covered during their induction. Evidence of this training was found in the personnel files that we examined. The people living in this home are registered with a local GP and notes are kept in their file of and treatment they have received from them. There was also evidence that people have access to other health professionals such as dentists and opticians. Other support such as psychology, speech and language and Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 13 occupational health therapy is accessed through the learning disability team based at the Bassett Centre. The Medication, its storage and records were examined during this visit. The home has the medication dispensed into blister packs by the chemist who also produces record sheets referred to as MAR sheets. There were gaps in the MAR sheets where staff had not signed to indicate that the medication had been given. We checked the blister packs and the medication had gone. It may be that the carer had given it but had not signed the sheet afterwards. It is important that checks are made and that the manager investigates mistakes. Some people were prescribed medication after the monthly cycle had been started, the details had been hand written and not countersigned. It is unsafe to handwrite medication details on records because if it is recorded wrongly or the handwriting is poor it will lead to mistakes being made that may affect the health of the person receiving the medication. This practice is against the Royal Pharmaceutical guidelines, they recommend that instructions should be printed by the pharmacy that dispensed the medication and only hand written if it really can’t be avoided and then the entry must be checked by two people and both must sign the entry as correct. The medication storeroom seemed very warm and we advised the manager that, because some medication is damaged if it becomes too hot, she should monitor the temperature in the storage area daily and take steps to maintain a safe temperature range in the room. There is a fridge for storing medication that needs to be kept cool, it is not monitored either. It is recommended that checks are made of the temperatures of both the storage room and the fridge, these should be recorded and action should be taken to correct any fluctuations. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Both standards 22 and 23 have been examined during this visit. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. There are polices and procedures in place concerning complaints and the people living in the home know how to make a one if they are unhappy. They feel that they would be taken seriously if they did. Complaints recording is good. Staff receive protection of vulnerable people training. EVIDENCE: During the visit we asked people living in the home if they understood the homes complaints procedures and if they knew who to complain to. They said they did. One person said that they had made a complaint and they were happy with the way it was dealt with. There is a complaints leaflet that sets out the home’s procedure. We looked at the way the home recorded any complaints and found that it was done in a way that made it easy to follow a complaint from the start to finish. We were assured that staff have received protection of vulnerable adult (POVA) training. The staff files showed evidence that it had been done and staff confirmed that they had taken the course. When questioned about adult protection they displayed a knowledge of how they would disclose an abusive situation they had witnessed or suspected. The home has policies and procedures about responding to suspicion or evidence of abuse. There are records that show the home has followed that procedure in referring suspected abuse to the appropriate authority and that they cooperated with the investigation. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 have been judged on this occasion. People who use the service receive Adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in this home experience a comfortable and homely environment. Some health and safety issues need to be addressed. Some of the decoration and furniture in the home is shabby and needs replacement. The home was clean and hygienic. EVIDENCE: Throughout the house there is a shabby and unkempt appearance. There was a requirement made at the last key inspection in August 2006 that the registered provider must ensure that all parts of the home inside and outside are kept clean and reasonably maintained. Because this work has not been carried out this requirement will be restated. If the work is not carried out within the given timescale, enforcement action may be taken. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 16 We talked to the manager about our concerns that the environment of the home was poor. She acknowledged that there was a lot to be done and that there were plans in hand to make improvements. She told us that work was also needed on the roof and it had been decided that while the roof was being repaired the people living in the home would move to temporary accommodation. This will enable all the work to be done in one go, which would be less disruptive in the long-term. It is also intended that new furniture be provided in some of the areas of the house. None of the bedrooms have furniture that matched and some pieces have broken doors and draws so it is essential that the furniture be replaced. The dinning room itself is a good size, light and airy but gives the appearance of being unattractive as the furniture is utilitarian and old, there are very few pictures or ornaments around and there were still a few Christmas decorations up. Some of the carpets are in a poor condition and we saw two areas on the stairs that were that were torn. These trip hazards must be replaced as they could cause injury. We have asked that the manager inform us when the work had been done so that we can visit the home again to see the improvements. The home was clean and hygienic throughout. A relative of someone living in the home told us that they liked the home and felt they cared for their relative well but they were frustrated because they had mentioned that the access ramp had moss on it and was slippery several times and nothing had been done. This made it slippery and difficult to use and could lead to people being hurt unnecessarily. We will require that the ramp be cleaned and kept clean in the future. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 and 36 were inspected. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The people living in the home are protected by the home’s recruitment policies and procedures. Staff have undertaken appropriate training and are qualified but have not received sufficient supervision. EVIDENCE: Three staff files were examined and we were able to talk with three members of the staff group. The home’s recruitment policy and procedure is as required and evidence was seen in the staff files that confirmed that it was carried out; criminal records bureau checks are undertaken and two references are obtained, the file also contained photographs and copies of the recruits application, a health declaration and other documents as required in Schedule 2. The majority of staff hold an NVQ qualification in care. Records show that training undertaken includes adult protection, managing diversity, infection Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 18 control, first aid, medication, fire awareness, care planning, moving and handling, food safety and health and safety. All of the staff we spoke with demonstrated a commitment to providing a caring and supportive environment for the people living in the home. We saw staff working and talking to the people living in the home in an open, respectful and friendly way. Notes were seen that indicate one to one supervisions occur but they are not happening as often as required which is at least six times a year. There were few supervision notes on staff files, the latest was dated November 2007. Supervision is not only an opportunity to give direction and assess training needs but allows staff to air concerns and make suggestions and regular meetings nurture a feeling of be listened to, of being involved and of being taken seriously. A recommendation will be made that the manager must establish arrangements to supervise staff and carry out annual appraisals on a regular basis. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39 and 42 were judged during this inspection. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in this home can be confident it is well run and that their views are taken into account in its running. Their health and safety will be protected. EVIDENCE: The manager has only been in post for four months and is still getting to grips with the job. She has not applied for registration yet. She has undertaken to apply to become the registered manager without delay. While we talked she displayed a good knowledge of the needs of the people living in the house and said that she was intending to revise the care plans to be more person centred and goal focused. She showed an awareness of work that needed to be done and was looking forward to making the house more Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 20 attractive and homely. Files and records were well organised and the manager was able to easily produce the information we asked to see. Staff we spoke to felt that the manager was easy to get on with and is supportive. People living in the home said she was nice and took time to listen to them. One person told us they were worried about the move while the work was being done as they do not like change and it makes them worry. We asked if we could talk to the manager about these concerns and we were told “Yes of course, and maybe you could tell her about my window rattling in the wind.” When we mentioned this persons concern the manager said she was aware of them and intended consulting people at every stage of the move and would make sure they know what is happening throughout. The manager undertook to try and stop the window rattling as well. The home has a quality control system in place and sends surveys to the people living in the home and their relatives annually. The latest survey has been sent out just after Christmas. Eight relatives responded to the surveys we had sent before the inspection and only one had any concerns. This concern was about the access ramp that has already been mentioned in a previous section. Health and safety checks are carried out and recorded. We examined a sample of safety records and they were found to be in order. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 3 x Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23.2d Requirement The registered provider must ensure that all parts of the home inside and outside are kept clean and reasonably maintained. Previous timescale 31/10/06 The manager must notify the commission when the planned work has been completed. The ramp used by people in wheelchairs to access the home must be kept clean and ready for use at all times. Timescale for action 07/06/08 2 3 YA24 YA24 23 23 07/06/08 07/04/08 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 YA20 Good Practice Recommendations It is recommended that all staff must have their training on the safe handling and administration of medication undated and have their abilities to work within the homes medication policy and procedures reassessed and these assessments must be retained on file. It is recommended that checks are made of the DS0000006880.V357391.R01.S.doc Version 5.2 Page 23 2 YA20 Ashwood House temperatures of both the storage room and the fridge, these should be recorded and action should be taken to correct any fluctuations. Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashwood House DS0000006880.V357391.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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