Inspection on 20/09/05 for Briarcroft

This inspection was carried out on 20th September 2005.

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

Briarcroft 07/01/09

Briarcroft 02/11/06

Briarcroft 15/03/06

Briarcroft 18/03/05

Briarcroft 05/10/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Briarcroft First Drive Dawlish Road Teignmouth Devon, TQ14 8TJ Lead Inspector Stella Lindsay Announced 20 September 2005 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. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Briarcroft Address First Drive, Dawlish Road, Teignmouth, Devon, TQ14 8TJ 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) 01626 774681 01626 774681 Mr John Patrick Walsh, Mrs Elaine Louisa Ann Walsh Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Dementia, over 65 years of age (18) of places Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Ground Floor to be registered for Service Users with OP category only Date of last inspection 18th March 2005 Brief Description of the Service: Briarcroft is a detached house, situated close to Teignmouth town centre and set back from the main road. There are sea views from some windows. Briarcroft is registered to care for up to 20 people over the age of 65, who may have dementia. There are a keypad locks on the main entrances, and an attractive level decked area in a garden that is secure. Accommodation is on two floors with a passenger lift to the first floor. There is a spacious lounge, separate dining area and a sun lounge. All but one room is for single occupation. There is a separate self-contained flat on the lower ground floor, which is registered for two residents who are frail elderly but who do not have dementia. The flat has two bedrooms, a lounge and dining area as well as its own kitchen and conservatory. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on a Tuesday in September 2005, between 10am and 5.45pm. It involved a partial tour of the premises, examination of care records, staff files and health and safety records. As well as discussion with the home owners, the inspector met with five staff, six residents, and a visiting relative. All other residents were observed in their daily life, and five residents and three relatives returned comment cards to the Commission for Social Care Inspection, and their views will be represented in the text. What the service does well: What has improved since the last inspection? The house has been painted externally, and is looking very smart. At the same time, four windows were replaced, to assure draft free windows that open with ease. The floor to the entrance hall has been levelled and recarpeted, and the area redecorated, to give a pleasant arrival to all comers. A flagpole has been erected by the front entrance, for the interest of residents and visitors. The new windows in the lounge assure safety, and the new green leather sofas in the conservatory provide comfort in style, and have firm arms Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 6 to promote independent movement. Name plaques have been produced for residents’ bedrooms. This was done in response to a suggestion from a resident, to help all to find their own rooms and not make mistakes – and it has been found to help staff put clean clothes in the right rooms as well. The laundry process has been improved. The system for keeping soiled clothes entirely separate from clean clothes has been improved, a system has been introduced to share the work amongst care staff, and to make staff more accountable for their work. A keyworker system has been introduced. This gives to individual staff the responsibility to assure that residents’ clothes are labelled, their cupboards are tidy, they have the toiletries they need, and that they take the resident out as often as practical for a walk, a coffee in town, or to do something indoors especially for and with them. This is recorded on a chart for each resident. A daily check by Senior Care staff of care practices has been introduced, to assure consistency of care and attention to detail. A Staff Induction pack has been introduced, to better prepare new staff for working with the residents. It includes a list of all procedures they need to be aware of, a photo of all the residents, the daily routine of the home, and a copy of the Service Users’ Guide. 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. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 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 Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 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) 1,2,3 Good information about the service is given to prospective residents and members of the public. Care is taken to assess a person’s needs before offering accommodation. EVIDENCE: The Home owners have produced information for prospective residents and their representatives which is clearly presented and includes all required information, including comments from residents. They have up-dated it to maintain accuracy. Also, they listen to enquiries from visitors, and include information that is highlighted in this way as being of interest and use to potential service users. Residents are given a contract before they move in, which confirms that the Manager has made the judgement that the person’s needs can be suitably met at Briarcroft. This specifies the date of admission, the room to be occupied, and clarifies what is included in the service. Possible reasons for discharge are specified, which currently includes a diagnosis of MRSA. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 9 Information is gathered before a service is offered. Assessments were seen on residents’ files from Community Psychiatric nurses and Occupational Therapists. Prospective service users should be aware that Briarcroft does not currently offer accommodation to anyone who has a diagnosis of MRSA. The Manager always visits prospective residents, to assure that people are admitted appropriately to Briarcroft, for their own well being and that of the other people living in the home. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 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 The personal care given at Briarcroft was seen to be good, and tailored to the needs of the individual. The health needs of residents are met, with effective collaboration with health professionals, and medication is administered with care. EVIDENCE: All residents have a care plan which addresses their emotional needs, and the approach to be taken in meeting these. Care needs, goals, action to be taken and on-going care are specified. The Deputy Manager has checked the care plans monthly, and there are signatures on files of relatives who have been consulted. Preferred daily routines have been recorded. Family members have provided life histories and personal information to enable staff to understand the new resident better. Residents may choose which staff member will help them with personal care. Carers are expected to leave until later, or ask for help from the Senior on duty, if a resident is not wanting to get washed or dressed. There is a bath book, but it is for recording, and making sure no-one’s care is missed, not to restrict choice, and residents can have extra baths by request or in case of need. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 11 A daily check by Senior Care staff of care practices has been introduced, to assure consistency of care and attention to detail. A keyworker system has been introduced. This gives to individual staff the responsibility to assure that residents’ clothes are labelled, their cupboards are tidy, they have the toiletries they need. This is recorded on a chart for each resident. Risk assessments are carried out shortly after admission. They were seen to consider hazards associated with moving and handling, and mobility, smoking, and infections as a possible cause of disturbed behaviour. The residents’ health care needs are documented in their care plans, with a separate section for recording G.P visits, weight, dietary needs and elimination. Residents are attended by their own GP. The Continence advisor is asked to assess all residents shortly after admission. Staff are aware of the need to take action to avoid pressure sores, and have received training. A resident had made a good recovery from a pressure sore which they had on admission, with District Nurses no longer needing to visit. A resident who was gravely ill was being cared for in their room, with support from the GP and fluid charts kept. Health professionals’ visits were seen to be recorded promptly. The psychiatric services have been consulted when there is concern over a person’s mental health or behaviour. Briarcroft has a Medication Distribution policy which meets the standard. No residents are assessed as competent to manage their own medication. The Senior on duty always administers the medication, but a total of nine staff have received training in dealing with medication and are aware of the effects of the drugs, and possible side effects. No homely remedies are used, and no Controlled Drugs, though a suitable method for recording and storage of these is in place. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 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) 12,15 Residents have the care and social activities that suit their needs, with staff taking responsibility for individuals in their role as keyworker. A variety of tasty and nutritious meals are served. EVIDENCE: The introduction of the keyworker system is resulting in more individual and small group outings, as staff have been given responsibility to consider the needs of particular residents. The key worker is expected to engage their resident in a way that suits them, which could be to take the resident out as often as practical for a walk, a coffee in town, or to do something indoors especially for and with them. Two residents had recently been taken out for lunch to a cliff-top hotel. A trip to the zoo was being planned, with consideration being given to inviting relatives. A visiting relative said that there ‘is always so much going on’, and that their mother had been taken out in the taxi, and stopped for tea and cakes. Care staff had done craft work with residents in the home, and lead music and dancing in the lounge. A list was displayed on the lounge door, showing the entertainments arranged for the month of September which included entertainers visiting for Music and Movement and other musical sessions, as well as a residents’ Meeting, and two birthday teas. All the residents spoken with said that they liked every meal they were given. The cook has introduced new dishes to the menu, with lasagne, chicken Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 13 curries, and roast dinners in the middle of the week. One resident has different tastes to the majority, and their needs are catered for. Fresh fruit and sugar free jelly and mousses are provided. A visiting relative said that their mother ‘loves the food’, and that the menu is always written up on the board, with choice of sweet shown. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 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) 16,18 Satisfactory arrangements for protecting residents and responding to their complaints are in place, and the Home owner has raised awareness of abuse within the home in order to encourage residents and staff to speak up if there is a problem, which is good practice. EVIDENCE: The Home has a complaints procedure that contains all relevant details as outlined in this standard. It is distributed to new residents and their representatives in the Statement of Purpose, and is displayed in the entrance hall. Any complaint is recorded, as well as the action taken. The Home has a policy on Abuse, Whistle Blowing and physical restraint. This is covered as part of the staff induction process. A Policy on Protection of Vulnerable Adults has been produced. The Devon County Council Alerters’ Guidance has been available to staff, who have signed to say they have read it. The Policies on Abuse and Whistle Blowing both include directions to staff on who they should speak to if they have any concerns. During a Residents’ Meeting, the Home owner raised the subject of what they should do if anyone shouted at them, and assured them that they need not put up with any indignity but should tell someone and it would be dealt with. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 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) 19,20,21,23,26 Briarcroft is an attractive and comfortable home, offering a variety of social spaces as well as all facilities required. The standard of maintenance and decoration is very good, inside and out. EVIDENCE: Briarcroft is an attractive house, set on the hillside above Teignmouth, with fine sea views from some rooms. There is a programme of maintenance and improvement. The house has been painted externally, and is looking very smart. At the same time, four windows were replaced, to assure draft free windows that open with ease. The floor to the entrance hall has been levelled and re-carpeted, and the area redecorated, to give a pleasant arrival to all comers. A flagpole has been raised for the interest of residents and visitors. The new windows in the lounge assure safety, and the new green leather sofas in the conservatory provide comfort in style, and have firm arms to enable independent movement. The grounds are kept in good order and there is a secure garden area for residents to enjoy without risk if they wander. All exits have a security keypad, which is linked to the fire alarm system. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 16 There is a large elegant lounge, with windows overlooking the garden and the view across the estuary. The dining room leads into the sun lounge. This gives access to the decking area and garden. The flat in the lower ground floor has its own lounge and conservatory. Toilets and bathrooms have been redecorated with attractive washable paper, and new flooring was being laid on the day of the inspection. Bedrooms are routinely refurbished on change of occupant. Three had been recently recarpeted. Two ladies share the one double bedroom. One has been offered the chance to move to a single room, and the other chose to move in with her. One resident who was ill in bed was able to see out of the window from their bed. Thermostatic valves have been fitted to hot taps in baths and residents’ hand basins to avoid risk of accidental scalding. Press taps have been fitted, so residents can use their own hand basins safely. All rooms are light, and window restrictors are fitted where necessary. There are wall lights in bedrooms as well as central lights. Attractive radiator covers have been fitted throughout. The Home has a comprehensive policy on infection control and staff confirmed they have completed training in infection control. There is a high incidence of continence problems amongst the residents, and staff are commended for maintaining good standards of cleanliness throughout the building. The procedure for dealing with laundry ensures that cross contamination between clean and soiled laundry is avoided. Liquid soap and paper towels were available in communal toilets. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 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) 27,28,29,30 Sufficient staff were on duty, competent and well trained to provide good care. The staff recruitment process was seen to be sound, to protect residents. EVIDENCE: A written rota is kept, which showed that there are generally four care staff on duty in the mornings, and three in the afternoons, plus a cook from 7.30am – 1.30pm every day, and a cleaner from 8 – 2pm. This is seen to be sufficient in terms of the residents’ personal care and time available for individual attention and social activities. At night there are two waking night staff, to provide care for the highly dependent residents. A new gardener had just been appointed. Twelve of the 18 care staff either have NVQ2 or equivalent, or are working towards it. The Deputy Manager and Assistant Manager are working for their NVQ3. The files of recently appointed staff were examined and found to contain the references and evidence of CRB clearances and checks on identity as required to ensure the protection of residents. New staff had been given a staff handbook and the GSCC code of conduct. The Manager keeps a training matrix, showing staff achievement in training. New staff have received in-house induction training, and a new induction pack has been produced, to help them be better prepared for work with the residents. Recently appointed staff have attended Foundation Training. Two more staff attended a training day on Dementia and Challenging Behaviour. There is a planned programme of training, with Health and Safety to be provided next, and selected staff to attend a session on Stroke at Torbay Hospital. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 18 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) 31,32,33,34,36,37,38 Briarcroft has been managed very competently, to provide a safe, caring, and responsive environment for residents and staff. EVIDENCE: The Registered Provider has many years experience in the care of elderly and dementia, has CSS and a management development certificate as well as a City in Guilds in teacher training and is an NVQ assessor. Both Registered Providers within the Home most days, are fully involved in the life of the Home, and are always available by phone contact if necessary. Residents and relatives said that they are very approachable. Staff said they always pleased to hear ideas, and will try them out. Staff meetings and residents’ meetings are held. The Home owners have a policy of continual improvement, and try to improve systems to provide consistently good service for residents. A quality audit is Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 19 held to check that safety checks such recording temperatures of fridges, food, and hot water are carried out effectively. A daily check of care practices by Senior staff has been introduced. The Home owners have daily discussions with staff, residents and visitors, and listen for suggestions. A quality assurance development plan has been drawn up for the year, with the objective of consistently monitoring daily routines and procedures, and evaluate them, to assess the effectiveness of different forms of communication, and to gather feedback from residents. The annual plan for the service covers recruitment and training, and improvement and extension of the property. Staff confirmed that they have individual supervision sessions with the Manager. Records are kept, which show that training and development are considered, and training needs identified, to ensure the continued competence of the staff. Record keeping at Briarcroft is generally very good, with all documents required during the inspection easily retrieved, clear and up to date. Individual care records are kept on separate sheets, and stored in the Care Plan, so that residents or their relatives may view them on request. Care staff should be guided to greater accuracy in daily recording, to promote better understanding of the behaviour they are recording. A record of a resident ‘wrecking’ their room was not a helpful or accurate statement, and a fall was recorded but not reported as an accident. The Manager has Incident forms, which help show any trigger for disturbed behaviour. The CSCI has been notified of reportable incidents. A new fire panel has been installed which is easier for staff to see and understand. Clear instructions and a list of residents and their room number have been produced and are displayed by the fire panel. The alarms are tested every week, and drills carried out by staff. Fire training has been delivered, including night staff. Moving and Handling training has been delivered, and Health and Safety training is booked. All electrical appliances were checked on 06/12/04, and the five year electrical installation test was completed on 11/03/05. The gas appliances were serviced on 31/05/05 and the lift examination carried out on 22/06/05. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 20 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 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 4 3 3 x 3 x 4 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 4 3 3 4 3 x 3 2 3 Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 21 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 Regulation Requirement Timescale for action 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 OP37 Good Practice Recommendations The Manager and Senior Carers should guide staff to greater accuracy in daily recording, to promote better understanding of the behaviour being recorded. Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon, TQ13 7UP 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 Briarcroft D54-D07 S3663 Briarcroft V239589 200905 Stage 4.doc Version 1.40 Page 23 - 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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