Inspection on 01/08/07 for Beech Street Home

This inspection was carried out on 1st August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Beech Street Home 21/06/06

Beech Street Home 27/09/05

Beech Street Home 20/05/05

Beech Street Home 14/09/04

Beech Street Home 20/04/04

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

CARE HOMES FOR OLDER PEOPLE Beech Street Home Jarrow Tyne and Wear NE32 5LD Lead Inspector Hilary Stewart Key Unannounced Inspection 10:00 1st August 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Street Home Address Jarrow Tyne and Wear NE32 5LD 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) 0191 483 5284 0191 489 8549 South Tyneside MBC Maureen Aziz Care Home 35 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (18), Learning disability over 65 years of age of places (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (3), Old age, not falling within any other category (35), Physical disability (1), Physical disability over 65 years of age (5) Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service may from time to time admit persons between the ages of 60 and 65 years of age. 21st June 2006 Date of last inspection Brief Description of the Service: Beech Street Elderly Persons home is a Local Authority purpose built home which is situated in Jarrow. The home is registered for up to 35 residents, some of whom have a dementia type illness. Nursing care is not provided but district nursing services are accessed as required. Accommodation is over one floor, with level access throughout, and consists of a number of communal areas, including smoking and non smoking lounges, and a separate dining area. Residents have access to a well-equipped reminiscence room and a separate hairdressing facility. There is spacious garden and car parking is available to the front of the home. The entrance to the home is particularly attractive with a water feature, plants and ornaments. The home is situated on Beech Street which is located close to the busy town centre of Jarrow where facilities such as shops, pubs, GP surgerys and places of worship can be easily accessed. The weekly fees for this home range from £94.75 to £408.75. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of the visit the home had an acting manager. The line manager of the home said that they hope to recruit a permanent manager soon. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 21st June 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service and the staff. The Visit: An unannounced visit was made on 1st August 2007. During the visit we: • • • • • • Talked with people who use the service, staff and the manager. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager and their line manager what we found. What the service does well: The staff team at the home value the differing needs of the people who live there and make sure that they are aware of each person’s preferences. They treat the people who live at the home as individuals and support them to live the life they choose as much as possible so they know they are valued. Staff enable the people who live at the home to experience a variety of activities so they have more choice. This helps build self-esteem and confidence. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 6 The staff team make sure that the home is warm and pleasantly furnished so the people who live at the home have a comfortable place to live. There are procedures in place at the home that make sure that the people who live there are protected and kept safe from abuse. The staff are supervised and trained so they know how to provide the people who live at the home with good care. The staff make sure that the peoples health care needs are met so they remain in good health. The home has a staff team who work well with each other and have worked together for a long time. This helps them provide good care and support to the people who live at the home. The acting manager is qualified and experienced so they can support the staff to meet the needs of the people who live at the home. What has improved since the last inspection? What they could do better: If the care plans had more detail staff would have accurate up to date information about how they can meet the needs of the people who live at the home and provide them with good care. If there were sufficient staff at the home they would be able to spent more time with individuals and take people out on more activities. This would mean that the people would receive an improved quality of care. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 7 If changes to medication were checked and signed by two staff this would reduce the chances of a mistake being made. This will safeguard the people who live at the home from receiving the wrong medication. If the home was improved and decorated. Also if the odour in some of the rooms was removed this would make the home a much more pleasant place for the people living there. If the quality assurance systems were in operation this will help the home to shape the quality of the service and ensure it is run in the best interests of the people who live there. If the fire drills, staff fire instruction and fire training were carried out as often as they should this would make sure that the staff at the home know the procedures to follow in case of a fire so they can safeguard the people who live at the home. 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. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home have all had their needs assessed before they were offered a place. This makes sure that they have the right type of care and the staff have the skills to me their needs. The home does not provide intermediate care EVIDENCE: The home receives an assessment from the persons care manager prior to admission. This information is looked at by the manager to see if the home can meet the person’s needs. A home visit is carried out as well prior to a person moving in. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 10 The home’s has a Service User Guide, which gives people information about the home and the service it provides. The people who live at the home have a contract from the home, it is not in an easy to read format. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All of the people who live at the home have individual care plans; some parts of the care plans had not been completed. This meant that the staff did not have all of the up to date accurate information about the needs of the people who live at the home and how they can be met. The people who live at the home are supported by the staff with their care needs so they can be as independent as possible. Staff monitor and promote the health of the people at the home to maintain their well-being by using a multi-agency approach. This helps the people stay healthy. The procedure for changes in medication had not been followed on one occasion. Staff respect the privacy and dignity of the people who live at the home. This is so the people know that they are valued as individuals. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 12 EVIDENCE: The manager said and records showed that each person who lives at the home has an individual care plan, which is based on their assessment of need. Some parts of the assessments and care plan had not been completed. Some of the care plans did not contain enough detail about what staff need to do to meet the needs of the person. The care plans looked at did not contain information about how to meet the social and emotional needs of people, information about their medication of personal safety and risk. One care plan provided information about policies and procedures for washing and transferring, but not information about how that persons needs were met or the actual assistance staff were providing. The manager said that the plans are reviewed regularly although this had not been recorded. Senior staff and some care staff have had training in the safe handling of medication. The medication records were up to date. Some handwritten entries in the records had not been double signed to make sure they were accurate. The manager and staff said that they have had training in how to administer medication. Records showed that the people’s health care needs are met at the home. Details of health checks, visits to their GP and hospital appointments are recorded in the individual files. The manager said that the health and welfare of the people who live at the home is monitored all of the time. The people who live at the home looked comfortable and relaxed. One person said, “ The staff are great” and another said, “ the staff are lovely and helpful”. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People at the home can take part in various social activities so they can make their own choices as much as possible and they know that their opinions and decisions are taken seriously. Activities are limited due to the staffing levels and lack of accessible transport. Friends and family are encouraged to visit the home at any reasonable time. This helps to prevent the people feeling and becoming isolated. Staff support the people who live at the home to make decisions and choices in their lives, which helps to promote their independence. The people who live at the home are offered varied, well-balanced and nutritious meals in comfortable and pleasant surroundings, which promote their health and well being. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 14 EVIDENCE: The home has a coffee morning every month at the home for the people who live there and their relatives. Staff said that an activities coordinator would improve the service as they could spent a lot more time on arranging and planning events than they can. Staffing levels are not sufficient at times and limit how often people can go out on trips especially those who use wheels chairs. The manager said that they have a newsletter for the people and their relatives to tell them about things that are happening in the home. Staff and the people who live at the home said that they would like to have more trips out. One person said that the activities programme is not followed. She would like to do craft work, knitting or any other activity like that to fill her time. One person was making themselves a cup of coffee in the kitchen area of the sitting room and said that they appreciated having the freedom to do this. The manager said that the home has pets as therapy now visiting and they have bought some new games and activities to be used in and out doors at the home. One relative said, “ I came to visit the other night and everyone was singing it was great”. The manager staff and the people who live at the home said that their relatives and friends are welcome and encouraged to visit at any reasonable time throughout the day and evening. Visitors were observed on the day, one relative said, “ We are made welcome” and they liked the home because “it isn’t regimented”. Another relative said about the person they were visiting “they like me to bring the dog to visit”. Records showed and staff said that the people who live at the home choose what they want to do during the day. They go to bed and get up when they want and staff said that they are always aware that they must support the people to be as independent as they can. One relative said, “they treat them like they are their own parents”. The home’s menus are based on the known likes and dislikes of the people who live there. One person said, “the food is good ” and “ I like curry and rice”. Special diets can be catered for. Hot drinks, fruit and snacks are always available throughout the day and evening. Each lounge has a fridge with cold drinks. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is in place and clearly displayed to ensure that that complaints are dealt with effectively and to the satisfaction of the complainant. Staff know about and have had training in adult protection so the people who live at the home are kept safe. EVIDENCE: Copies of the homes complaints procedure are displayed in the home. The manager and staff said that the people who live at the home and their relatives know how to make a complaint. On relative said “I would complain if I wasn’t happy about something”. Records showed that there had been one complaint made since the last inspection. This has been dealt with by the manager. One of the people at the home when asked if they knew how to make a complaint said, “ Yes I would”. The manager said that all of the staff team have received training in Protection of Vulnerable Adults (POVA) procedures by the Local Authority. The home has copies of the POVA procedures for staff to access. Staff said that they have had the training and they did know what to do if someone disclosed abuse to them. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some parts of the home are comfortable, clean and generally in good repair. Other areas were in need of repair and require attention. If this work were carried out the home would be a more pleasant house for the people to live in. EVIDENCE: The home has gone through some areas of redecoration, Some areas of the home need attention they are: 1. Some carpets have burn marks on them and need to be replaced. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 17 2. The wooden handrails have chipped paintwork that could be a hazard to delicate skin. The manager said that these are to be replaced, as they don’t comply with disability regulations. 3. Material pull cords in bathrooms need replacement, as they are likely to increase the chance of cross infection. Also toilet brushes placed on toilet cisterns may be a hazard given the level of confusion evident in some people who live at the home. 4. The bathrooms are bare and fairly institutional, in some cases tiles have fallen off and not been replaced. 5. In one bedroom the bedding was worn and frayed. 6. Rooms 7 and 8 had an unpleasant odour. 7. In the laundry, soiled linen on the floor was beside dirty table linen. This could increase the risks of cross infection. The home is mainly clean and reasonably well furnished. People said that they were happy with the accommodation apart from the smoking room. One person said that they were very grateful that there is a smoking area, however they would like a bit more comfort with nice chairs and a TV. It would be better because they and the other smokers would feel comfortable while watching the TV and having a bit of a chat. The smoking room is poorly furnished with old hard dining chairs, which some residents may find difficult to get out of without staff assistance. No other furniture is in the room apart from a tin ashtray. Gardens are spacious, but need better maintenance. Paving is uneven and could present a hazard to residents. The home has staff employed to keep the home clean and hygienic. However due to staff sickness the remaining staff have to carry out extra work. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are insufficient numbers of staff in post to meet the diverse needs of the people who live at the home. The home has a recruitment procedure to vet staff so the people who live there are kept safe. Staff get regular training and supervision this helps them learn the necessary skills to provide the people who live at the home with good care. EVIDENCE: The manager said that 85 of the staff have vocational qualifications. Records showed and staff said that they have mandatory training regularly such as first aid and food hygiene. At the time of the visit sufficient staff were on duty. However the manager and staff said that the home does not have enough staff, care and ancillary, to adequately cover the rota. The staff are flexible and will work overtime but they said they do need time off for rest so they can carry out their jobs to the best of their ability. The line manager of the home said that more staff should be recruited soon. Records showed that on most days enough staff had been Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 19 on duty but staff were working extra hours. One person who lived at the home said that they thought there were always enough staff about. The manager said that all staff have been CRB (Criminal Records Bureau) checked at an enhanced level to make sure they are suitable people to work at the home. Records showed that some staff had had all of the checks carried out. Staff said that they did not start to work at the home until they had gone through the local authority recruitment process. Staff said and the manager and records confirmed that they have individual supervision and are supported to do their job. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The temporary manager is qualified and experienced to run the home in the best interests of the people who live at the home. The home has procedures in place that make sure resident’s finances are safeguarded. Staff had not received fire instruction and fire drills as often as they should. This could be a risk to the safety of the people who live at the home. The home does not have a quality assurance system which would help the home shape the quality of the service it provides and ensure it is run in the best interests of the people who live there. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 21 EVIDENCE: The acting manager said that they are qualified and experienced to run the home. It was observed that there was a pleasant rapport between the people who live at the home the manager and staff. They also said that they liked the manager and thought they were supportive. The home has procedures for staff when they deal with the people’s money so it is kept safe. Written records are kept of all of the people’s finances and transactions and receipts are kept. Staff sign records when any of the money is used. Records showed that some fire drills and staff instruction have taken place but not as often as they should. Some staff have not had then mandatory fire training. Electrical equipment through the home had been safety checked. The manager said that the home does not have a quality assurance system but they hope to have on in the future. Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 23 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 OP7 Regulation 15(1) Requirement Care plans must continue to be developed to provide staff with detailed guidance on the action they need to take to address the residents assessed needs. (Timescale of the 31/10/06 not met) Systems must continue to developed to obtain the views of residents and their relatives as well as the development of an internal self-monitoring system. (Timescale of the 31/03/05 and 30/11/06 not met) All staff must receive refresher training in fire safety (timescale of the 31/10/06 not met). The Statement of Purpose and Service User Guide must be developed to provide information on how the home is suitable and able to meet the needs of people with dementia and people with a DS0000037970.V340152.R02.S.doc Timescale for action 31/10/07 2. OP33 24 31/10/07 3. OP38 23(4) 31/10/07 4. OP1 4(1)(b) 31/10/07 Beech Street Home Version 5.2 Page 24 sensory impairment. (Timescale of the 30/08/06 not met) 5. OP9 13 The registered person must make sure that staff double sign the medication records when any changes are made. The maintenance issues discussed in the report must be addressed. In order to prevent the risk of cross infection the light pulls ion bathrooms must be replaced and soiled bedding should not be placed beside table linen in the laundry. All areas of the home must be free from unpleasant odours. The registered person must make sure that the activities programme takes place. The registered person must make sure that there sufficient staff employed at the home to meet the needs of the people who live there. 30/09/07 6. OP19 23 31/10/07 7. OP26 13 30/09/07 8. 9. OP12 OP27 16 18 31/10/07 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beech Street Home DS0000037970.V340152.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Beech Street Home DS0000037970.V340152.R02.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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