Inspection on 15/08/06 for Barlby Road

This inspection was carried out on 15th August 2006.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barlby Road 14/04/09

Barlby Road 21/07/08

Barlby Road 08/10/07

Barlby Road 05/12/05

Barlby Road 09/05/05

Barlby Road 25/10/04

Barlby Road 12/07/04

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 Barlby Road 37 Barlby Road North Kensington London W10 6AN Lead Inspector Sheila Lycholit Unannounced Inspection 15th August 2006 10:15 Barlby Road DS0000010843.V302170.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 Barlby Road DS0000010843.V302170.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. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barlby Road Address 37 Barlby Road North Kensington London W10 6AN 020 8964 8543 020 8964 8156 info@yarrowhousing.org.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) Yarrow Housing Limited Miss Kim Alexandra Poller Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: 37 Barlby Road is a residential home for four people with a learning disability. The service is provided by Yarrow Housing Limited in a building owned and maintained by Kensington Housing Association. All of the service users, two men and one woman, are supported by RBKC. The building is a semi-detached house in North Kensington, which has been adapted on the ground floor for wheel-chair access. The lay-out of the house provides one bedroom on the ground floor and three on the first floor. All rooms are single and of a good size. There is an office/sleep-in room in a loft extension. Service users attend day services in the Borough and are supported to pursue a range of leisure interests. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Tuesday 15th August 2006 from 10AM until 2.45PM. One service user was having his breakfast and left on a pre-planned shopping trip with a member of staff. The other 2 service users were attending day services. The vacant place at Barlby Road has been provisionally allocated and the prospective service user and her family are visiting the service, while an assessment takes place. The monthly staff meeting took place from 1PM to 3PM. The Manager, who had completed a pre-inspection questionnaire, made herself available throughout the visit. The Inspector looked around the building and spoke with 2 members of staff in private. Two comment cards were received from visiting professionals who made positive comments about the service. What the service does well: What has improved since the last inspection? What they could do better: Person in Control visits take place irregularly, with only 4 taking place this year. Training in adult protection, fire safety and in the administration of Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 6 medication is provided too infrequently by Yarrow’s training unit, resulting in new staff not completing core training within six months of starting. The number of staff with NVQ2 or 3 is low, though this should improve in time as the majority of staff are now enrolled on training. 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. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 7 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 Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 8 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, 2, 3, 4 and 5 The quality of outcomes for these standards is assessed as excellent. A well designed Statement of Purpose and Service User’s Guide are available, which are in an accessible format and are regularly reviewed. Assessments are comprehensive and involve the multi-disciplinary learning disability team. A sound and careful admissions procedure is followed. Contracts are detailed and are accessible. EVIDENCE: The personal files of the 3 service users were looked at. Each contained a copy of the Statement of Purpose, Service User’s guide and contract. All of the documents are in an accessible format and are specifically designed for Barlby Road and its service users. Each of the documents had been recently reviewed and re-issued. For the first time for many years a new service user was being assessed for Barlby Road. Care has been taken to offer the place to someone who would be compatible with the current residents in terms of communication, age, cultural background and interests. The service user and her family have visited the home on a number of occasions. The Social Worker, Occupational Therapist and Physiotherapist were all involved in the assessment. Information, including risk assessments, had been sought from other services that the prospective resident currently uses. The Manager had not been given a copy of the care needs assessment, which she said she would request. Staff showed their Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 9 obvious enthusiasm for working with the service user whom they felt would be compatible with the present long-standing residents. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 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, 7, 8, 9 and 10 The quality of outcomes for these standards is assessed as excellent. Service users communication is supported to allow them to make choices about their lives, to fully contribute to their person-centred plans and to take part in the daily life of the house. Individual risk assessments are well written, comprehensive and are regularly reviewed. EVIDENCE: Person centred plans, using photos, signs and symbols, as well as text, have been developed for each service user. PCPs include photos of service users at home, on holiday, on trips out, shopping and with families and friends. Although there have been delays in reviews carried out with the Local Authority Reviewing Manager, staff have undertaken regular reviews of PCPs. All PCPs were seen and each was up to date and contained an action plan. Objectives and goals agreed with service users were specific with dates set for implementation or achievement. Staff supervision notes show that senior staff monitor the implementation of action plans closely. In addition to their PCP folder, each service user has been supported to create a collage that represents their interests, likes, dislikes and aspirations. Yarrow’s Multi-Media Co-ordinator has been working with one service user to find ways of assisting him to use a PC, so that he can communicate his needs, choices and interests via video footage and photos. The Speech and Language Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 11 Team have supported the development of communication passports and objects of reference, which are now in every day use. Support guidelines are available. These are written in the first person and show how each person wishes to be supported with personal care. Risk assessments are comprehensive and are regularly reviewed. Each of the service users poses different risks as a result of their disability and behaviour. Few restrictions are placed on service users, with staff trying to support them to take part in community activities as far as possible. The front door is kept locked as none of the service users can safely go out alone and the kitchen is also kept locked at times to reduce the risk to service users. Staff have found ways of involving service users in choosing furniture and fittings for their rooms and for the sitting room. Staff are also trying to include service users in staff selection by meeting applicants prior to formal interviews and by contributing to the development of person specifications. The home has a confidentiality policy and personal records, such as service users’ health and financial information is stored in the office, which is kept locked when not in use. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 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 and 17 The quality of outcomes for these standards is assessed as excellent. Service users take part in a wide variety of activities outside the home. Relationships with families and friends are well supported. Staff have encouraged service users to eat more healthily and to choose a wider range of food. EVIDENCE: Records, photos and discussion with the Manager show that service users take part in a wide range of activities. While service users attend specialist services such as Scope and The Gate, they also follow individual interests with the support of staff, including the Day Activities Worker. As discussed earlier in the report photos and text in PCPs show people on holiday, on trips out, for example to Richmond Park and to Brighton, in restaurants and spending time with friends and families. One service user is a keen Rambler and regularly goes on organised walks, sometimes accompanied by a friend. One service user has had to give up the use of her Motability car because of the high costs. Staff are trying to arrange alternative transport, such as taxis. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 13 All service users go on an individual holidays, accompanied by staff. Yarrow Housing has fund-raised to allow one service user to go on holiday, which has now been booked. Work experience has been arranged for service users. Steps have been taken to encourage service users to widen the variety of foods chosen and to eat more healthily. Service users are supported to shop individually, which the Manager reported has encouraged them to try new foods. One service user is supported by staff to shop at stores selling Caribbean food and to eat at Caribbean restaurants in the area. Meals and snacks out are enjoyed by service users. The Manager had contacted the CSCI for advice regarding the funding of meals out, which residents normally pay for themselves. It was agreed that the Service User’s Guide would be amended to show more clearly when service users would pay for meals and when the home would fund meals out. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 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, 20 and 21 The quality of outcomes for these standards is assessed as good. Staff have a good understanding of service users support needs and preferences. Service users health needs are regularly reviewed and staff work with the multi-professional learning disability team to access health care services. There are sound procedures for administering medication. The death of a service user last year was handled sensitively. EVIDENCE: Support guidelines are based on service users’ preferences regarding personal care and give detailed information about the way in which person is to be supported. A health action plan has been developed for each service user with the help of the Learning Disability Specialist Nurse. Records and discussion show that staff have taken steps to ensure that service users receive any necessary treatment. Staff have advocated strongly on behalf of one service user who had to wait many months for urgent dental treatment. Specialist equipment has been obtained for service users based on the OT’s assessment. The use of prescribed medication other than creams and lotions is currently low. MAR sheets seen were up to date and fully completed. The Manager confirmed that delays in Yarrow’s provision of medication training result in some staff administering medication before they have attended training. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 15 However, all staff are trained in-house before administering medication and shadow an experienced member of staff. Staff have continued to support service users over their loss of a fellow resident who died last year. Photos of him are displayed in the house and a memorial service was recently held. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 16 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 and 23 The quality of outcomes for these standards is assessed as good. Staff have worked hard to develop ways of eliciting service users’ concerns, including using the local advocacy service. Yarrow has a well-designed and accessible complaints booklet and procedure. Steps are taken to protect service users from abuse and harm, including finance abuse. EVIDENCE: There have been no complaints or adult protection referrals since the last inspection. Staff have worked with the local advocacy service to develop ways of eliciting service users concerns. These are included in the quality assurance report and include issues such as delays in getting repairs carried out and the constraints of living with other residents. A copy of the local multi-agency adult protection policy and procedures is available in the office. In the absence of sufficient training workshops in Yarrow’s programme on adult protection, the Manager has held a session inhouse using the RBKC training materials. In discussion, a member of staff commented that she had found this session very helpful. The recent financial records of each of the 3 service users were looked at. These were in good order, with receipts for all purchases. The Manager regularly signs to show that she has checked the financial records. Service users cash accounts are reconciled monthly. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 17 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 and 30 The quality of outcomes for these standards is assessed as good. Service users live in a pleasant semi-detached house that is indistinguishable from its neighbours. The ground floor has been well adapted for wheelchair use. The décor and furnishings have been much improved over the past 2 years. Staff take steps to keep service users safe within the building, while recognising that they have a variety of needs. EVIDENCE: Some further decorating has been undertaken by staff since the last inspection and new furniture, chosen by service users and curtains have been purchased for the sitting room. The building is spacious, with all bedrooms of above average size. During the inspection visit one service user went out with staff to purchase items for his room. The vacant room was seen, which the Manager said would be decorated to the new resident’s taste when her admission was confirmed. The building has a number of bathrooms and lavatories, which are adapted for service users’ needs. The advice of the Occupational Therapist and Physiotherapist are regularly sought to ensure that service users are provided with equipment to meet their changing needs and to support their independence. Staff have added as much tactile signage as possible to assist one service user who has a severe visual impairment. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 18 The front garden has been tidied since the last inspection visit and the rear garden has a number of additional plants given in memory of the service user who died last year. The building was very clean and tidy at this unannounced visit. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 19 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): 32, 33, 34, 35 and 36 The quality of outcomes for these standards is good. A permanent staff team has been established that is able to provide consistent support to service users. Staffing levels are good and allow service users to take part in activities during the evenings and weekends, as well as during the day. Staff are well supported through regular supervision and staff meetings. Staff have access to Yarrow’s training programme, which includes NVQ training, though the number of staff who have completed NVQs is currently low. Yarrow has a sound recruitment procedure that includes service users on interview panels. EVIDENCE: The staff team consists of 11.5 posts, including the Manager and 2 Deputy Managers. All posts have been filled with permanent staff. The Manager said that the staffing establishment would be increased when the vacant place in the home was filled. Staffing levels and rotas allow service users, all of whom have high needs, to take part in a variety of activities throughout the week, including some evenings. Staff are available 24 hours, with one member of staff sleeping-in each night and one staff on waking night duty. As a result of staff turnover and some staff not completing their NVQs on time, the percentage of staff with NVQ2 or above is currently low. However the Manager was able to confirm that all support staff who are not undertaking other qualifications have been enrolled on NVQ3. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 20 All new staff and bank staff undertake induction training, which is recorded by means of a checklist. Records and discussion with the Manager show that some staff have not completed fire safety training, adult protection or medication training within 6 months of starting at the home. The Manager has tried to compensate for delays in Yarrow’s training programme by providing in-house training. The records of 2 members of staff were looked at. These were in very good order, with records of recruitment checks, induction, probationary reports, detailed supervision notes, and an annual appraisal. Records showed that performance issues had been addressed. In discussion both members of staff interviewed confirmed that they felt supported and, in addition to regular supervision, had frequent opportunities to discuss issues with senior staff. The monthly staff meeting took place on the afternoon of the inspection visit and was attended by the majority of staff. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 21 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): 37, 38, 39, 40, 41, 42 and 43 The quality of outcomes for these standards is assessed as good. The Manager has been confirmed in post and has continued to develop the service, in particular the involvement of service users in all aspects of the service. An excellent quality assurance report has been produced based on feedback from service users. Support for the Manager has improved, with monthly supervision from the Head of Care services. There continue to be delays in visits on behalf of the provider, which are taking place infrequently. EVIDENCE: The Manager, who was previously the Deputy Manager, has been confirmed in post. She knows the service well and has continued to implement developments in the service. An experienced senior staff team, that works well together, has been put in place. The Manager confirms that she receives monthly supervision for the Head of Care who visits the home. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 22 Service users views on the service are continually sought and with the help of the advocacy service have been formally elicited and form part of an excellent quality assurance report. Yarrow Housing has developed other ways of involving service users including a monthly Tenants’ Forum. Yarrow Housing’s Investors in People Award has been renewed, with conditions. Yarrow Housing has comprehensive policies and procedures that are regularly updated. These are available in the home and on the intranet. Recording is of a good standard, including service users files, handover sheets and health and safety checks. Health and safety policies and procedures are in place. A number of regular checks are carried out. Night staff take fridge, freezer and hot water temperatures daily and check equipment such as wheelchairs. The fire alarm system is serviced 4 times a year and fire fighting equipment twice a year. Both were last serviced on 5th July 2006. Fire drills take place 4 times a year and are recorded. There have been 3 accidents/ incidents recorded this year. Relevant risk assessments were reviewed. Cleaning materials are kept in locked cupboards. There is guidance on infection control but this needs to be updated and to be more comprehensive. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 4 2 3 3 4 4 3 5 4 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 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 3 3 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 3 3 3 3 3 3 3 2 Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 24 No 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 YA35 Regulation 13, 18 Requirement New staff must be provided with training in the administration of medication, adult protection and fire safety. Steps must be taken to ensure that a higher percentage of staff employed at the home have achieved a minimum of NVQ Level 2 or above. Visits on behalf of the provider must take place at least monthly and be recorded. Timescale for action 30/09/06 2 YA32 18 30/09/06 3 YA43 26 30/09/06 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 YA42 Good Practice Recommendations The policy and procedure on infection control should be revised and cover all issues in the home, such as soiled linen. Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Barlby Road DS0000010843.V302170.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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