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Inspection on 20/07/05 for Breckside Park Residential Home

Also see our care home review for Breckside Park Residential Home for more information

This inspection was carried out on 20th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Pre-admission assessments were being undertaken and prospective residents were invited to spend time in the home before making a decision to stay. Good working relations were in place with GP`s, district nurses, the pharmacist and other health care professionals visiting the home. Residents commented favourably about the care and support provided by staff at the home. They were also complimentary about the food served in Breckside Park. Staff were ensuring that residents were able to make choices about their dayto-day lives. Some progress had been made to ensure staff were provided with appropriate training.Breckside Park Residential HomeVersion 1.30 F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.docPage 6

What has improved since the last inspection?

Residents had been offered a copy of the home`s service users guide. Some repairs had been carried out and replacement carpets had been fitted. An application has been received by CSCI to register a manager at the home.

What the care home could do better:

Improvements to the care planning arrangements are required. The appointment of an activities organiser would assist the social and occupational development of residents in the home. Routine maintenance checks would ensure that faults are rectified early. Staffing levels should be reviewed to ensure the manager can spend time developing care planning, record keeping and staff development at the home. Improvements are required to the information kept on staff appointments at the home. The manager should ensure that individual, professional staff supervision is undertaken at least six times each year.

CARE HOMES FOR OLDER PEOPLE Breckside Park Residential Home 10 Breckside Park Anfield Liverpool L6 4DL Lead Inspector Les Hill Unannounced 20 July 2005 9:15 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 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. Breckside Park Residential Home Version 1.30 F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Page 3 SERVICE INFORMATION Name of service Breckside Park Address 10 Breckside Park Anfield Liverpool L6 4DL 0151 260 6491 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Keshav Khistria CRH PC 26 Category(ies) of PD - 2 registration, with number OP - 21 of places MD(E) - 3 Breckside Park Residential Home Version 1.30 F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1 February 2005 Brief Description of the Service: Breckside Park is a registered care home providing personal care for up to 26 residents in the category of older people. The home has been granted variations to the registered status to permit the care and support of named people in the category, younger disabled. The home is situated in the Anfield area of Liverpool and is close to parks, shops and public transport routes. Communal space within the home consists of 2 lounges, a dining room and a large conservatory. The home has 26 single bedrooms five of which have an en-suite WC. The home benefits from a large enclosed rear garden and further garden areas to the side and front of the home. Breckside Park Residential Home Version 1.30 F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection at Breckside Park took place on Wednesday 20th July 2005 over a period of 5 hours. It involved the examination of some records, a tour of the building, and discussion with five residents and one visitor to the home. The inspection was part of the Commissions requirement to visit and report on each registered care home on two occasions each year. What the service does well: Pre-admission assessments were being undertaken and prospective residents were invited to spend time in the home before making a decision to stay. Good working relations were in place with GP’s, district nurses, the pharmacist and other health care professionals visiting the home. Residents commented favourably about the care and support provided by staff at the home. They were also complimentary about the food served in Breckside Park. Staff were ensuring that residents were able to make choices about their dayto-day lives. Some progress had been made to ensure staff were provided with appropriate training. Breckside Park Residential Home Version 1.30 F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc 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. Breckside Park Residential Home Version 1.30 F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Page 7 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 Standards Statutory Requirements Identified During the Inspection Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4, 5 and 6. Relevant information was in place to inform prospective residents about the home. Adequate pre-admission assessments were being undertaken. EVIDENCE: The home’s statement of purpose and service users guide were examined during the previous inspection by CSCI and were found to contain all the relevant information required in National Minimum Standards. A recommendation from the inspection in February 2005 was that residents should be given a copy of the service users guide. The acting manager told the inspector that residents had been offered the guide but had refused to take their own copy. Contracts/statements of terms and conditions of residency will be examined at the next announced inspection. Pre-admission assessments were in place on the three resident’s files sampled during the inspection. The information was adequate and would enable staff to draw together a plan of care. However the documents would benefit from the Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 9 inclusion of information about family make up, social background and hobbies and interests. The levels of need identified were within the scope of a residential care home. The three residents files sampled were those of younger adults (i.e. below the age of 65years). Each of them contained an assessment of need that was appropriate for the home to meet. Admission procedures encourage prospective residents to visit the home and to spend some time there before making the decision to stay. In practice however, prospective residents agree to the placement and move in straight away. The home has admitted residents in an emergency situation. Policies and procedures for managing the admission are in place. The home does not provide Intermediate Care. Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11. Some additional work is required to ensure that care plans are recorded appropriately and that notes from regular reviews can be included. Medicines were being managed in accordance with good practice standards and residents were being provided with the support they needed. EVIDENCE: The new care planning documents introduced on the day prior to the CSCI inspection in February 2005 had not been fully implemented. The main booklet contains some valuable information on which care plans can be developed but some elements are more appropriate for care homes with nursing. Additionally the booklets have a working lifespan of 18 months and the manager will need to consider how best to ensure any care planning arrangements produced in the new documentation can be continued and monitored after that period of time. The Commission expects that reviews will be undertaken monthly but the new documentation has sections for monthly reviews in the first six months and six monthly reviews thereafter. Care plans in the new format were not in place for all of the residents. The acting manager told the inspector that she is working to complete the care plans in conjunction with the home’s group manager. Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 11 The acting manager told the inspector that residents receive good support from GP’s and the district nursing service. Additionally the services of an optician, dentist and chiropodist are made available as required. The continence adviser assists with assessments and the provision of appropriate equipment. Records in the home identified that five residents had been taken to Accident and Emergency departments at local hospitals since the inspection in February 2005. None of the residents have a pressure sore. A random examination of the medicines kept in the home was undertaken and found to be in line with expected procedures. Except in one case where the home keeps a controlled medicine that is administered by the visiting district nurse. The controlled drugs register must be completed and the district nurse and a member of staff at the home must sign to confirm that the appropriate dosage has been given. The acting manager told the inspector that she is well supported by the pharmacist who visits on a monthly basis to check the supplies and procedures and has offered to provide some training for staff in the effects of the medicines used for residents in the home. The inspector spoke with four residents in the home and with one of the resident’s visitors. All of them were complementary about the care provided by staff in the home and confirmed that they were treated with respect. During a tour of the building the acting manager knocked on each of the bedroom doors and waited for a reply before entering. The home has policies and procedures in place for staff to support residents who are dying. The acting manager has begun the process of recording the wishes of residents to ensure appropriate procedures are followed at the time of their death. Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Care staff organise activities in the home but the appointment of an activities organiser would ensure more regular interventions for individuals and groups of residents. Residents were encouraged to make decisions about their own lives. Food provided in the home was of a good quality. EVIDENCE: Some of the residents are able to go out from the home independently. Care staff organise parties, bingo sessions and a sing-along for all the residents who wish to join in. The commitment of the care staff to encourage activities in the home is to be commended but much of their time has to be spent in meeting the personal care needs of residents. The appointment of an activities organiser would enable individual residents, small groups of residents and the full group where appropriate to benefit from a structured approach to the encouragement of social stimulation and occupation in the home. Visitors to the home are welcomed at any time. Additionally when staff time is available they will take residents out from the home to the local park or to the shops. Residents who spoke with the inspector said they were free to make decisions for themselves about their day-to-day life in the home. They could decide what Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 13 time they got up and what time they went to bed. They could choose how to spend their free time and had a choice of foods at each mealtime. The care plans for some of the residents seen during the inspection identified that individuals were spending time in their own room and on one of them the plan identified the need to encourage the resident to spend more time mixing with others. The acting manager confirmed that staff would encourage socialising in the home but would always respect the wishes of the resident. The home’s menus identified a full and balance diet. A main meal was served at each mealtime but residents could choose something different. Special diets were catered for. Residents who spoke with the inspector were complimentary about the quality of food served in the home. Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18. Complaints are taken seriously and acted upon. The home should provide training in the correct procedures to be followed when residents are considered to be at risk of abuse. EVIDENCE: The home has a complaints procedure in place that is displayed in the hallway at Breckside Park. A complaints report form is provided to record the process of investigation and any outcomes. No complaints have been made directly to the home since the CSCI inspection in February 2005. One complaint was received by CSCI but when investigated was found to be not proven. All of the residents are listed on the Electoral Register and have the opportunity to vote in national and local elections. The home has a policy and procedure in place to deal with incidents of abuse and to encourage staff to raise any concerns. The acting manager was advised to contact Liverpool’s adult protection unit to obtain a copy of their procedures. The acting manager told the inspector that she is to meet with a representative of a local college and will be requesting them to provide training in adult protection for staff at Breckside Park. Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. The home was clean and well cared for but routine maintenance checks should be made to identify and repair faults as they arise. EVIDENCE: Breckside Park is situated in a quiet street in the Anfield district of Liverpool. The home is a former dwelling that has been adapted to provide care and support to 26 older people. A passenger lift and staircases provide access to the upper floors. Since the CSCI inspection in February 2005 the ground floor corridor carpet has been replaced; blinds have been fitted to the lounge windows to protect residents from the sun; dining room chairs have been replaced; a radiator guard in room 32 has been repainted and the outside garden wall has been rebuilt. A number of maintenance issues remain outstanding and some new matters were raised with the homeowner during this inspection. Some of the chairs in Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 16 the lounge are quite worn and should be recovered or replaced; bedroom 30 still requires redecoration and the hole in the door needs to be repaired; stairways should be kept clear and not used to store furniture; two fire doors leading onto the stairs were wedged open. When the wedge was removed the doors wouldn’t close properly onto their rebated frame; Some of the bedroom doors would not close properly onto their rebated frame; A toilet on the first floor identified to the acting manager, was leaking and a radiator in the room was rusting and the paint was flaking off; A panel has yet to be fitted to the wall by the lift on the ground floor to prevent further damage from wheelchairs. The homeowner should arrange for routine inspections of the building to identify faults and to ensure they are repaired as soon as possible. A programme of ongoing improvement to the decoration was in place and bedrooms are being repainted as they become vacant. On the day of this inspection the home was clean and free from offensive odours. The vacancy for a domestic has been filled. Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. Staffing levels agreed with the former registering authority should be reviewed. All required information should be gathered at the time of staff appointments to the home. Training opportunities for staff were being developed. EVIDENCE: Staffing levels agreed with the former registering authority were being maintained. The manager’s hours are rostered from 8:00am ‘til 5:00pm but the dependency levels of the resident’ means that she has to spend a good portion of her time providing personal care. The homeowner should review the staffing arrangements at the home to ensure the manager has sufficient time to carry out her responsibilities in care planning and review, in maintaining the homes records and in the professional supervision of other staff. The home has fifteen care staff (excluding the manager) and the inspector was informed that three of them have an award at NVQ level 2. The acting manager told the inspector that a representative from one of the colleges is to visit the home in the next week and all of the staff, not currently qualified will be signed up to work towards an award at NVQ level 2 in care. This will be essential if the home is to achieve the minimum standard of 50 care staff with NVQ level 2. A sample of staff recruitment files identified that not all of the required documentation was being put together before staff were being appointed to Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 18 work in the home. Two of the files had only one reference; two files did not contain confirmation that CRB/POVA checks had been carried out and two files did not contain sufficient evidence of identification. The homeowner must ensure that recruitment and selection processes in the home are robust and offer protection to vulnerable residents. The homeowner described some difficulties being experienced in gaining a response from CRB about particular members of staff. He was advised that he must pursue the matter to ensure clearances are obtained. Staff files contained certificated evidence of training completed. The acting manager told the inspector that she is arranging for initial and “top up” training in first aid, moving and handling and adult protection for all staff. The acting manager was reminded that she should also arrange for regular fire prevention training in the home. Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 and 37. Confirmation of a registered manager at Breckside Park is essential if the home is to build on and improve its ability to meet all of the National Minimum Standards. EVIDENCE: The home has been without a registered manager for more than two years. The acting manager has submitted an application for registration to CSCI that is currently being processed. The acting manager is working towards an award at NVQ level 4 in the management of care. The atmosphere in Breckside Park at the time of this inspection was busy but calm. Residents who spoke with the inspector were complimentary about the staff and said that they worked hard. Residents have recently told an inspector Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 20 that they feel safe in the home and were receiving the levels of support that they needed. Staff were observed to get on with their work and to talk with residents in a friendly and respectful manner. The acting manager told the inspector that she had begun the process of formal staff supervision but had not yet been able to meet the standard of meeting with them every six weeks. The freeing up of the managers time to undertake staff supervision is essential if the home is to invest in its staff development programme. The home has a good set of policies and procedures in place that should be seen to form the basis of its work. Previous inspection reports have sought to confirm that staff are reading the policies and procedures. The inclusion of a staff signature sheet with each policy on which they confirm the date on which they read it would assist the process. The home’s Employers Liability Insurance Certificate was displayed on the office wall and was valid until April 2006. Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 2 3 x x x 2 2 x Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 22 yes 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 OP7 Regulation 15 Requirement The manager must ensure that comprehensive care plans are in place to support staff in providing appropriate levels of care. The homeowner must ensure that the premises are kept in a good state of repair internally and externally The homeowner must ensure that staffing levels at the home are kept under review and make appropriate provision for the manager to carry out her responsibilities. The homeowner must ensure that the records of staff specified in Schedule 4 of the National Minimum Standards are kept in the home. Timescale for action 31/08/05 2. OP19 23(2)(b) 31/08/05 3. OP27 18(1)(a) 31/08/05 4. OP29 17(2)(3) 31/08/05 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 OP9 Good Practice Recommendations The manager should ensure that controled drugs used by F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 23 Breckside Park Residential Home 2. 3. 4. 5. OP12 OP18 OP28 OP36 the district nurses are managed and recorded in the same way as all other medicines in the home. The homeowner should consider the appointment of an activities organiser to enhance the opportunities for social and occupational interaction amongst residents. The homes manager should obtain a copy of Liverpool City Councils policies and procedures on adult protection. The homes manager should ensure that at least 50 of care staff have an award at NVQ level 2 in care by the end of 2005. The homes manager should ensure that all staff have formal, professional supervision not less than six times each year. Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 24 Commission for Social Care Inspection Liverpool Area Office 3rd Floor 10 Duke Street Liverpool, L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Breckside Park Residential Home F52_F02_s25331_BrecksidePk_v239448_200705_Stage_4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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