Inspection on 16/01/07 for The Old Hall

This inspection was carried out on 16th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Old Hall 23/08/07

The Old Hall 19/01/06

The Old Hall 27/06/05

The Old Hall 11/10/04

The Old Hall 02/08/04

The Old Hall 23/02/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Boughton Hall Boughton Hall Send Marsh Road Send Ripley Surrey GU23 7DJ Lead Inspector Susan McBriarty Unannounced Inspection 16th January 2007 10:00 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 Boughton Hall DS0000013570.V325445.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 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. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Boughton Hall Address Boughton Hall Send Marsh Road Send Ripley Surrey GU23 7DJ 01483 211674 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) The Old Hall (Send) Co Ltd Charles Patrick Geoghegan Care Home 40 Category(ies) of Dementia - over 65 years of age (4), Learning registration, with number disability (1), Old age, not falling within any of places other category (40), Physical disability over 65 years of age (5) Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: over 65, one named person may be aged between 60 and 65 19th January 2006 Date of last inspection Brief Description of the Service: Boughton Hall (The Old Hall) is situated in a rural location a short distance from the village of Send. It is a large detached property set in its own substantial grounds. There are ample parking facilities at the front and the side of the building. Service users bedrooms are provided at ground and first floor level and all have en-suite facilities. The home has a wide variety of communal spaces including several lounges and dining areas. These are all situated on the ground floor; the standard of presentation, decoration and furnishings was very high. The home has a large patio area and extensive gardens at the back of the building. The fees charged in this service range from £520 to £625 per week. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit of a key inspection and was unannounced. The inspection took place over five and a half hours. The inspection was carried out by Mary Williamson, Regulation Inspector. The acting home manger represented the establishment. A tour of the premises was undertaken and records relating to the care of the service users and the management of the home were examined. Discussions were held with several of the service users were spoken to both individually and in small groups. There were very positive comments forthcoming regarding the standard of care received and the staff providing this. There were various activities taking place in the home. The activities coordinator was organising individual activities, the hairdresser was busy in the salon, some service uses were reading their paper, or having coffee in small groups. Some service users were observed enjoying a glass of sherry prior to lunch. The kitchen was visited and the chef spoken to. Lunch was observed and the food on the menu was appetising, and wholesome which was confirmed by service users comments. Discussions were held with staff both in groups and individually. They were able to demonstrate a good understanding of individual service users needs. The training coordinator was able to demonstrate the training programme in place for staff and how individual training files are maintained. Recruitment procedures were sampled and three-employment record were seen. These contained all the relevant documentation to comply with employment legislation. The manager completed a pre inspection questionnaire. Fourteen relative comment cards and sixteen service users comment cards were returned to the inspector prior to the inspection with generally favourable comments which have been included in this report. CSCI would like to thank the service users, manager and the staff for their help and hospitality during the inspection. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? All of the requirements made at the previous inspection have been met. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 7 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. Boughton Hall DS0000013570.V325445.R01.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 Boughton Hall DS0000013570.V325445.R01.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): 1, 2, 3,and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information available to help them make a choice about living in the home. Care needs assessments are completed prior to a service user being admitted to the home. This home does not provide intermediate care. EVIDENCE: The home has a statement of purpose and service user guide in place and all prospective service users and their relatives have access to a copy of this prior to admission to the home. There is also a copy of this in individual bedrooms. The manager explained to the inspector the admission process. Following the initial enquiry the manager undertakes a brief assessment of needs, which is undertaken in more detail over a four- week trial “assessment period”. Needs assessments were seen for MM, JM, EH, and MD. These are well maintained, informative, and give a good holistic view of service users needs. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 10 These are reviewed by the head of care at regular periods or when someone’s needs have changed. Terms and conditions of occupancy are in place and were sampled. These outline the fees paid and the method and frequency of payment. The home does not charge for hairdressing, newspapers, or chiropody. The home does not provide intermediate care. Boughton Hall DS0000013570.V325445.R01.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, 10, and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health, personal, and social care needs are being met as outlined in individual care plans. The home’s policies and procedures for dealing with medication are satisfactory, and staff treat service users with dignity and respect. EVIDENCE: The care plans sampled were comprehensive, well written and outlined all aspects of care to be undertaken. The acting manager stated that the head of care compiles the care plans with input from service users and their relatives. Care plans are kept in service users bedrooms and are updated daily. The arrangements in place to meet the health care needs of the service users are satisfactory. All the service users are registered with a local GP who visits the home every Wednesday or more frequently if required. Several service users commented on the good level of support they receive from the GP. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 12 The chiropodist visits the home frequently and all service users have treatment at least every six weeks. Chiropody charge is inclusive of fees. A domiciliary optician visits on request and the inspector was told that arrangements are in place for a domiciliary dentist to commence visits to the home in February 2007. The Community Psychiatric Nurse visits every Monday, and specialist support can be accessed on referral by the GP. Service users living in the home are protected by the home’s policies and procedures for dealing with medicines. Medication is only administered by staff that have undertaken the relevant training and have been assessed as competent to do so. There is a list of these staff names on the medication file. Lloyds Pharmacy supplies medication weekly in NOMAD format. The medication recording charts were seen and are well maintained. Following a discussion with the deputy head of care it was suggested that a photograph of individual service users could be kept in the front of individual medication recording charts for identification and safe practice. The head of care keeps an audit trail of medication entering and leaving the home and all medication is stored correctly. One service user self medicates two items of medicine and a risk assessment is in place for this procedure. Throughout the inspection staff were observed undertaking various aspects of personal care for service uses in a respectful and professional manner. They were observed to be polite and address service users by their preferred name. Staff were seen to knock on individual bedroom doors and wait to be invited in. The home manager explained that at the time of death service users and their families would be treated sensitively and with dignity. He explained how spiritual needs are respected. He also stated that the previous day the home provided a funeral reception for the family of a deceased service user, which was also attended by some current service users. Boughton Hall DS0000013570.V325445.R01.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, and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged and supported to maintain fulfilling lifestyles according to preference. Community and family links are encouraged. The catering arrangements are good and meet the nutritional needs of service users. EVIDENCE: The home has an activity news -sheet, which is published every month and available to all service users and their relatives. Activities include selected videos, quiz, and exercise to music, flower arranging, pat dog, scrabble and games. Two coordinators arrange these activities, at various times in both lounges and the activities room. Musical afternoons and piano recitals are also arranged. Trips out for afternoon tea, and trips on the river Wey are organised depending on the weather. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 14 During a discussion with various groups of service users they stated that they enjoyed the programme offered and also enjoyed their friendship groups. Seating arrangements promote an informal atmosphere and service users stated that they like to sit with individual groups of friends. Several service users have a daily newspaper. Special events are celebrated and all the staff sang “Happy Birthday” to one service user in the dining room during lunch with a specially made birthday cake by the chef. The acting manager stated that spiritual needs are supported and a Holy Communion Service is organised in the home, dates of which are included in the activities news- sheet. Members from various clergy are welcome in the home and visits can be arranged on request. Community activities are encouraged and some service users go to an activity centre. Visitors are welcome in the home at any reasonable time and relatives were observed to come and go during the inspection. Several service users stated that they had been out with relatives over the Christmas period. One service user had been to lunch to celebrate a recent birthday and the hairdresser ensured that she had her hair done earlier that morning. It was not possible to talk with relatives but sixteen relative comment cards were returned to the inspector, which expressed a general satisfaction with the home and the care provided. The catering arrangements in the home are very good. The chef plans the menus over a four-week rota, which is varied and meet the nutritional needs of the service users. The menus are displayed in the kitchen and on both notice boards outside both dining rooms. However when the inspector asked some service users what was for lunch they did not know, nor did some staff. It is recommended that menus are displayed in larger print or are available on the tables so service users are reminded what to expect for lunch. Breakfast is served in service users bedrooms. Lunch was observed and consisted of sausage plat, cauliflower cheese, potatoes and green beans. A selection of hot and cold deserts followed. Whilst the home does not routinely offer two choices of main course several service users stated an alternative could be asked for if required. Lunch was served in two dining rooms according to individual needs and staff were observed to offer sensitive support to service users who required help with feeding. Several service users spoken to stated that the food was excellent. The acting manager stated that arrangements can be made for relatives to have a meal with service users. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 15 The kitchen was visited and was clean and orderly. The chef has two kitchen assistants for support. Food hygiene regulations were being adhered to and records of fridge and freezer temperatures are being maintained. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 16 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. The service users are protected by the home policies and procedures around concerns, complaints, and safeguarding vulnerable adults. EVIDENCE: The home has a complaints procedure in place, which is also included in the service users guide. All service users and their relatives have access to a copy of this procedure. Service users stated that they were aware of this procedure but felt that any groans or niggles are dealt with and a formal complaint would not be necessary. The home has an abuse awareness policy in place and all staff have training in this during induction training. During discussion with staff they were able to explain the procedure to follow if an abuse situation arose. The training coordinator was also able to demonstrate the training pack used. There is a copy of Surreys Multi Agency Policies and Procedures for Safeguarding Vulnerable Adults in place and all senior care staff have attended training in these procedures, which has been cascade throughout the staff team. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 24, and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good and meets the needs of the service users, providing a safe, well maintained, clean and pleasant place to live in. EVIDENCE: The home was clean and tidy and well maintained. There is ample communal accommodation provided which includes two large lounges, two large dining rooms and an activities room. There is a conservatory designated as the smoking area, which is well ventilated and deodorised. Furniture was arranged to provide comfortable informal seating areas. Service user’s accommodation is provided in individual en-suite bedrooms, which are comfortably furnished and personalised to reflect individual Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 18 personalities. Telephone sockets have been installed to enable service users to have a personal telephone in their room. Sufficient toilets and bathrooms are situated throughout the home, which have been adapted to meet the mobility needs of the service users. Adaptations have been made to aid mobility and grab rails are situated in appropriate places. There is a shaft lift to access the first floor and there is a ramp to access the gardens. Call bells are available in individual rooms and in various locations throughout the home. The home has a redevelopment and refurbishment plan in place for the original building. This should include plans to decorate the upstairs corridor as some of the paintwork has become damaged from wheelchair traffic. The laundry is well equipped and facilities are in place for the management of infected linen. The laundry assistant was aware of the homes control of infection policy. The standard of cleanliness is very well maintained by the team of five housekeeping staff. Arrangements are in place for the collection of clinical waste. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The skill mix and number of staff were sufficient to meet the assessed needs of the service users. The recruitment procedure and training arrangements protect the service users living in the home. EVIDENCE: The staff duty rota was seen and the number and skill mix of staff on duty was sufficient to meet the needs of the current service users in the home. There are eight care staff on duty during a morning shift with a senior care member of staff in charge. This is reduced to five care staff during the afternoon shift with a long overlap period to support service users at lunch. The home also employs a chef, two kitchen assistants, five housekeepers, a receptionist, maintenance person two activities coordinators, and a training coordinator. The recruitment procedure in place is robust, and protects service users. Employment records were seen for JS, LL, and MK. These are well maintained and contain all the required employment documentation including two written references, an employment history and a CRB (Criminal Records Bureau) reference number. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 20 The home employs a training coordinator who is responsible for all the training needs in both of the organisations homes. A discussion took place between the inspector, the manager and the trainer regarding the training undertaken in the home. All new staff undertake induction training on their first day in a classroom setting. This is followed by a period of supervision from six to twelve weeks depending in individual circumstances. The trainer stated that over 85 of the staff employed are trained to NVQ level 2 or above. Currently there are five staff undertaking NVQ level 3. The training files sampled evidenced this. Formal supervision of staff is in place, which is the responsibility of both deputy heads of care. This takes place every six to eight weeks. Staff appraisal takes place in the form of “staff reviews”. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 21 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 home is well managed and was functioning well. The health, safety, and welfare of service users are protected by the home’s policies and procedures. EVIDENCE: The home is well managed and was functioning efficiently. The current registered manager does not have overall daily responsibility of the home and visits the service weekly. The acting home manager who was the designated representative throughout the inspection has been in post fro sixteen months. A discussion took place between the inspector and the manager regarding the registration process. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 22 A letter has been sent to the provider asking him to respond to The Commission for Social Care Inspection outlining the management arrangements for the home. The current acting home manager has overall responsibility for the home. He is supported by the head of care who is a qualified nurse. Two deputy heads of care with a combined experience of over thirty years also make up the management structure of the home. There is also efficient administration support in place. Several service users were complimentary about the management arrangements within the home and stated that they were always kept informed of any changes affecting them or their daily routines. Personal finances are not managed by the service and items such as newspapers, hairdressing and chiropody are inclusive of fees. Policies and procedures relating to health and safety were sampled throughout the inspection. Safety checks are routinely carried out at the home by the maintenance person or designated staff, for example water temperatures, fire drills, fire alarms, emergency lighting and the call bell system. Risk assessments are in place for identified risks and safe working practice. Four service users smoke and although there is a smoking policy in place, individual risk assessments must be completed and retained in individual records for this practice. This is to promote safe practice and the safety of all the service users in the home. Boughton Hall DS0000013570.V325445.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 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 3 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 24 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 OP31 Regulation 8(1)(iii) Requirement The registered person must appoint an individual to manage the care home if he does not intend to be in full-time day- today charge of the home. The registered person must ensure that unnecessary risk to health and safety are identified and as so far as possible eliminated, this includes implementing individual risk assessments for the four service users that smoke. Timescale for action 16/02/07 2 OP38 13(4)(c) 16/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations It is recommended that service users have access to the menus prior to the meal being served. Although menus are displayed on the notice board some service users are unable to see them and were not aware when asked what was for lunch. DS0000013570.V325445.R01.S.doc Version 5.2 Page 25 Boughton Hall 2 3 OP9 OP19 It is recommended that a photograph of service users is included on the front page of medication recording charts for safe practice. It is recommended that the redecoration of the corridor in the old building be incorporated into the refurbishment plans of the home. Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Boughton Hall DS0000013570.V325445.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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