Inspection on 24/01/08 for Bracken Tor House

This inspection was carried out on 24th January 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Bracken Tor House 11 Brandize Park Okehampton Devon EX20 1EQ Lead Inspector Anita Sutcliffe Unannounced Inspection 24th January 2008 09:45 Bracken Tor House DS0000070460.V349997.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 Bracken Tor House DS0000070460.V349997.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. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bracken Tor House Address 11 Brandize Park Okehampton Devon EX20 1EQ 01837 55209 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) Care Worldwide (Devon) Ltd Miss Katie Jane Freeman Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 5. Date of last inspection N/A Brief Description of the Service: Bracken Tor is a care home providing personal care and accommodation for five adults aged 18 - 65, with learning disabilities. It was newly registered in 2007 when a change of ownership occurred. The current owners are Care Worldwide (Devon) Ltd. A full time manager is employed for day to day management of the home. The home, consisting of a semi-detached, four-storey house, is located in a residential street of Okehampton, close to local shops, facilities and amenities. It has five single bedrooms, one on the lower ground floor, three on the 1st floor and one on the 2nd floor. The bedroom on the lower ground floor has an en suite toilet and en suite shower. In addition to the en suite facilities, there are two bathrooms and four toilets. On the ground floor there are separate lounge and dining rooms. The home has a small garden to the front and rear of the property, which is accessible to the service users. The fees charged are between £750 and £1,081 a week. An additional charge is made for hairdressing and personal items such as toiletries. Written information about the home, called the Statement of Purpose and Service Users Guide, are available on request. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. Information about the home has been collected towards this inspection since it was registered under new ownership in August 2007. This was the first inspection of the new service and included one unannounced visit to the home. Prior to the visit surveys were sent to people who use the service, their families and staff. The registered provider sent us current information about the home and described its strengths and areas considered for improvement. We asked the local district nursing team if they had any concerns about the home. As part of the visit to the home we looked at all communal areas, and some bedrooms. We spoke with people who use the service and observed staff going about their work. Only three of the five people who use the service were at home during our visit. We looked at the care and support that three people received, speaking with two of them and looking at their records. We spoke with the registered manager, the person (called the responsible individual) who is registered to take responsibility on behalf of the organisation Care Worldwide (Devon) UK, and some staff. We also looked at other records at the home. People who use the service may be described within this report as residents, clients or service users. What the service does well: People who use the service have a warm, clean, homely and properly maintained environment in which to live. Their needs are understood. They are supported to develop and there is a range of activities available to them. People are closely involved in the planning of their care and support. Risks are assessed and properly managed at the home. Staff are keen to do a good job, are properly recruited, trained and supported by the manager. Staff have empathy and understanding of the particular needs of people at the home. Staff, the manager and the provider organisation are working as a team. Measures are being developed to ensure a quality service. People have access to a robust complaints procedure and are protected from abuse. They will be listened to. All policies and procedures are currently being reviewed and where possible these are being produced in a format that people who use the service will be able to understand and benefit from. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bracken Tor House DS0000070460.V349997.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 Bracken Tor House DS0000070460.V349997.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service and their representatives have the information needed to choose a home which will meet their needs. EVIDENCE: Most people using the service have lived at the home for many years, so initial assessments would now be outdated. The manager confirmed that there had been no new person at the home since 2006. Written information about the home, which is available on request, provides detail about what may be expected by a person wishing to move there. The manager intends to add more pictorial information to this in the future to help those whose reading skills are limited. This will help any person who might wish to live at Bracken Tor be well informed about the home. We saw and discussed the forms which would be used to assess the needs of any potential new resident. All paperwork at the home is currently under review by the new manager. She confirmed that any potential new admission would be visited at their home if at all possible, a full assessment of their Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 9 needs would be made and they would be invited to Bracken Tor to meet other people who use the service if it was felt the home could meet their needs. We were told that since the home was re registered all people using the service have a new agreement specifying the arrangements made at the home. Bracken Tor House DS0000070460.V349997.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives and take an active role in panning the care and support they receive. EVIDENCE: The family of one person using the service said: “The home has given our son a lot more self confidence and a feeling of independence that would not be possible at home”. A member of staff said: “We provide a relaxed home environment which isn’t institutionalised”. Each person living at Bracken Tor has a written plan of how his or her care and support will be provided. Each plan has been reviewed in the last few months; the person using the service fully contributes to this. Staff say there is a monthly staff meeting at which they discuss people’s care and are able to share current information which might be relevant to the care planning. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 11 The manager is currently revising the style of care planning at the home. The intension is for more emphasis on the person as an individual – person centred care. We saw one of the new types of plan completed; it fully described the person’s desires and needs and the specific ways in which staff should provide support. In addition, both the manager and a care worker were able to describe in detail how his needs were to be met, each demonstrating a good understanding of his condition and how that affected his life. We saw that risks are being properly assessed as part of the planning of care and steps are taken to remove or minimise any risk identified without adversely affected the quality of the person’s life. Bracken Tor House DS0000070460.V349997.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: We met and spoke with two people who use the service and saw another going about his preferred daily routine. We were told that no person at the home has paid work; none want to. However, each is being encouraged to be more involved in the running of the home, something not promoted as much in the past history of the home. To this end each person cleans their own room with help, has involvement in handling their laundry, choosing the menu, shopping and some people help to prepare the meals. The manager says changes in people’s routine are “measured and taken slowly”. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 13 People have a variety of activities available to them. These include: • Attending a local drama group. • Coffee mornings and shopping. • Sport and swimming. • Arts and crafts at the local college. • Use of the library and CD collection. • Occasional theatre trips. • Helping at local riding stables. Each person’s rooms contain items of importance to them; hobbies and interests are promoted. None choose to attend a place of worship at this time. Most chose a holiday during 2007, well supported by the home and staff. The family of one person who uses the service said: “My son has been provided with a variety of activities that he has responded to very well”. The home uses taxis or staff cars to transport people to events, and the manager is applying for concessionary travel passes. Staff commented that it would be good if the home could have its own vehicle. One of the people who uses the service, asked about the food, says he gets what he wants to eat. There are recipe books at the home and from these each person chooses a meal in the week. Their differing choices help maintain a balanced and varied diet. We saw fresh, good quality food in the home and the manager says a lot of salad is eaten. Bracken Tor House DS0000070460.V349997.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. The safe handling of medicines could be further improved. EVIDENCE: We saw that the individual and specific personal care needs of people are described in the new style of care plan. The plan we saw had been produced with the person’s full involvement and direction. The manager says each person is to be provided with a ‘Health Book’. We saw one recently completed. She is working through these with each person in turn and, unlike the care plans, they will be kept by the home (for confidentiality) unless the person prefers to keep it themselves. The health books contain information pertaining to the person’s physical, mental and emotional needs, for example, how to help them reduce anxiety. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 15 We saw evidence that health care is promoted, for example, appointments for chiropody, hearing tests and psychiatric referral. Currently each person requires assistance to attend appointments and this is provided. One of the care staff said through survey: “All service users have the best care given”. People who use the service said they are treated well. A district nurse with knowledge of the home said the community nursing team “had no issues with the home”. The home is proactive in promoting good health for people and to this end pays for some non-NHS funded therapies for people. However, we found that ‘well-woman’ and ‘well-man’ preventative health checks could be promoted more fully. We looked at how the home manages the medicines for the three people who require them, none of whom are able at this time to do it them selves. Although the medicines are kept in a locked drawer, and the key for that drawer is kept in a locked key safe, the key to the key safe lives on a hook in the kitchen. This is not sufficiently secure storage of medicines. It would be quite possible for people/staff, with a little knowledge, to gain access to the medicines in the home. We were told that only one person is prescribed a variable dose of medicine, and it is clear, within their care plan, how staff will decide which dose to administer. The medicine records, with one small exception, had been properly completed and the information within them was clear. We saw that medicines were checked into the home, as they must be to ensure they are handled properly. Currently the home does not have a policy or procedure for the use of ‘over the counter’, none prescribed medicines, such as analgesia and cough remedy. The home should consult with peoples’ general practitioners and ensure this policy will be available to staff at the first opportunity. These remedies should also be kept separate from prescribed medicines and medicines which are kept at the home for staff. Bracken Tor House DS0000070460.V349997.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure. They are protected from abuse. EVIDENCE: The two people who use the service and responded to survey said they knew who to speak to if they were unhappy, on adding: “The staff”. Both said they were treated well. Family of people in the home confirmed they knew how to make a complaint and that the home responds appropriately if they raise any issues. We saw that people were comfortable in the presence of the staff which indicates they trust them. The manager has prioritised her review of policies and procedures and so people now have a pictorial version of the complaints procedure, clearly informing them that complaining is ‘OK’. The written, and more detailed, complaints procedure contains other details such as timescales for investigation. However, the home reports that they have not received any complaints. The Commission has received no complaints about the home. We looked at the home’s whistle-blowing policy, which informs staff what action they should take if they are concerned for the welfare of people at the home. The policy was very clear and contained contact details for all people staff may wish to take their concern to, for example the police and local Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 17 authority. Staff also receive training in how to protect vulnerable adults from abuse and those spoken with were clear what they should do. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people to live in a safe, well-maintained and comfortable environment. EVIDENCE: We found the home, which is situated over four floors, to be warm, clean, fresh and well furnished. Bedrooms are particularly individual, containing differing styles of furnishings and set out as mini-lounges with comfortable seating. Bathrooms were homely and again nicely furnished. People have the option of locking their bedroom door if they wish for privacy. The kitchen was clean and well equipped and the laundry, although small, is adequate for the current needs of people at the home. Staff have protective clothing (gloves and aprons) available for use to promote good hygiene. The home appeared well maintained and in a good state of repair. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 19 Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. EVIDENCE: Both staff who responded to survey said there were usually enough staff to meet the individual’s needs of all the people who use the service. Both said their training, when new, was satisfactory and they are kept up to date with new ways of working. Some staff have been with the home (during its previous ownership) for many years providing stability for people who live there. Staff say they receive information on how to work effectively and safely. This includes training in the condition of autism, the protection of vulnerable adults, food hygiene and fire safety. One staff member said training was: “Pretty good”. Two staff have achieved the National Vocational Qualification (NVQ) level 2 in care (or above) and two are enrolling to do level 2. Completing this award is Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 21 an indicator of competence. Some staff have been ‘in the work a long time’ and chose not to take this training, but the organisation is encouraging all staff to do it. The manager intends to find out about the Learning Disability Awards Framework, another source of training for staff and specific to the needs of people with learning disability. Family representatives asked if care staff have the right skills and experience to look after people properly, felt they did. We looked at the recruitment records of the most recently employed member of staff and found that all checks, necessary to ensure they would be safe to work the vulnerable adults at the home, had been properly completed. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and has effective quality assurance systems under development by a qualified, competent manager. EVIDENCE: People who use the service appeared relaxed and ‘at home’. Staff feel they have the right support from management. One said: “The place is run as an easy going and relaxed place for the service users. Family of one person said: “It is difficult to fault the service provided”. The manager Katie Freeman has worked in the care industry for over fourteen years, seven specifically in the field of learning difficulties. She has achieved Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 23 the National Vocational Qualification (NVQ) level 4 in Management and NVQ level 3 in Promoting Independence and so is suitably qualified to manage the home. The Commission approved her as the manager in August 2008 since which she has helped toward a smooth transfer of ownership of the home. One staff member said: “Kate is liked”. Ownership of the home changed in June 2007 and Mr. Alan Goldstein, who represents the organisation, is in frequent contact with the manager, visiting the home weekly. One visit coincided with the inspection visit. Both he and the manager have clear ideas on how the home will develop and appeared to be working closely together towards continuing improvement. A method for measuring the quality of the service provided is being considered. Currently there are monthly staff meetings and a way of surveying opinion about the home is being devised. Being a newly registered home it is acceptable that this is still a work in progress. However, we required information about the home toward this inspection and it was not forthcoming within the required timescale, which it must be to comply with the regulation. We found that staff are properly supported. One said: “Very good team with good communication”. Staff are properly trained in health and safety and no health and safety concerns were identified during the inspection. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 X X 3 X Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 25 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement Only the designated staff member, responsible for handling medicines in the home at that time, should have access to the medicines. This ensures they are kept secure and cannot be mishandled. To this end the medicine keys must be inaccessible to others. Information required by the Commission must be supplied by the due date. Timescale for action 31/01/08 2. YA39 24(2) 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations There should be a policy and procedure on how ‘over-thecounter’, non-prescribed medicines can be administered to people. This will ensure staff use them safely and consistently. Bracken Tor House DS0000070460.V349997.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Bracken Tor House DS0000070460.V349997.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. 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