Inspection on 27/04/06 for Carlton House (30)

This inspection was carried out on 27th April 2006.

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

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

Other inspections for this house

Carlton House (30) 05/12/05

Carlton House (30) 16/08/05

Carlton House (30) 02/11/04

Carlton House (30) 21/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOMES FOR OLDER PEOPLE Carlton House (30) 30 Chatsworth Road Croydon Surrey CR0 1HA Lead Inspector David Halliwell Key Unannounced Inspection 27th April 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Carlton House (30) Address 30 Chatsworth Road Croydon Surrey CR0 1HA 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) 020 8688 7801 020 8688 7801 Dr Emmanuel Owusu Akuffo Mrs Celia Erica Akuffo Mrs Celia Akuffo Care Home 15 Category(ies) of Learning disability over 65 years of age (0) registration, with number of places Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to seven (7) residents may be 50 to 64 years of age. Date of last inspection 5th December 2005 Brief Description of the Service: Carlton House is a privately owned home for 15 people with learning disabilities, at present there are twelve service user’s residing at the home whose ages range from fifty upwards. Carlton House comprises of two large houses made into one with connecting corridors. It is situated in a residential area a few minutes walk from the centre of Croydon and the main railway station. There is off street parking for a number of cars. There are eleven single rooms and two twin rooms. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of one day. The Inspector found the residents and staff very helpful and they are to be thanked for the assistance they gave him over the inspection visit. A number of residents and staff were interviewed and many of the unit’s records were reviewed. The Inspector was impressed with the friendly, supportive atmosphere within the home and how the residents are evidently living happily here. A number of service improvements have been made since the last inspection and some of the previous requirements have now been met. This is positive progress which must be maintained and lessons learnt from previous difficulties. What the service does well: What has improved since the last inspection? Individual staff supervision and the recording of decisions made and new objectives has improved. The home is on track to ensure that each member of staff has individual supervision at least six times in each calendar year as required under the national minimum standards. The structure and recording of residents meetings has improved and there is better communication with residents on key issues that are important to them. Appropriate risk assessments and reviews have now been carried out for new residents and the Inspector has been advised that this will now be done routinely for any new residents. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 6 Information and contact details regarding a local advocacy service have been put up on display for residents should they need or wish to use it. The unit’s response to a recent report undertaken by the LFEPA in early April 2006 identified 4 requirements which needed to be met. All of these requirements have now been met and it should be said that this represents a speedy and satisfactory response to the LFEPA’s report which is to be commended. 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. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 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 the following standard(s): 1, 3, & 4. While service users are told what the home does and how it will do it the service user guide still needs to be updated and should include all the elements set out in 4, 5 & 6 of the regulations. However service users and their representatives can be confident that their needs will be assessed and how they will be met by the home. EVIDENCE: At the time of the last inspection two new residents had recently been admitted and there were associated problems with these admissions which resulted in a number of requirements issued by the Commission. One area of concern was to do with the category of one of the new residents not being compatible with the existing registration conditions of the home. The other was to do with risk assessments not having been completed for both these service users. Since the last inspection risk assessments have now been satisfactorily carried out for both these residents. The Inspector reviewed the files of these 2 service Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 9 users and their risk assessments which do now cover the areas of risk and need for these residents and identify strategies for dealing appropriately with their needs. Satisfactory risk assessments were also seen on 3 other service users files reviewed by the Inspector on this inspection visit. One of the new residents was thought to have mental health problems as a primary diagnosis and this would have contravened the registration conditions and could have meant that the home would not be able to meet this persons needs. Since that time the diagnosis of this service user has been reviewed and clarified with the appropriate clinical professionals who have confirmed to the Inspector that this service user has a diagnosis of learning disability and not mental health problems. At the time of this inspection the Deputy Manager told the Inspector that risk assessments will be carried out for all new admissions and this was supported by the evidence found by the Inspector on service users files. There have been no new admissions to the home since the last inspection and so the requirements made at the last inspection cannot be monitored at this stage. However all future new admissions will be reviewed to check that these requirements are being met. The service user guide has not yet been updated but the Inspector was told by the Deputy Manager that this is underway at the present time. This recommendation therefore remains and a revised document needs to be published and made available to all prospective and new service users. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 & 10. The Service users can feel confident that their personal care needs and physical and emotional health needs will be well met by this home. This ensures that the service users have the opportunity to maintain their dignity, have their rights respected and continue to enjoy a good quality of life. Service users can also have confidence that their health care needs will be attended to and that will receive the support and treatment that they need. EVIDENCE: The Inspector reviewed 5 service users files of the 12 residents living at the unit and found in each case a risk assessment and individual care plan had been drawn up. The care plans cover the health, personal and social care needs and how they will be met. These individual care plans are reviewed regularly within the home every month and with external referring professionals every six months and include the allocated key workers from the home and the service users and their families where appropriate. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 11 The Inspector interviewed a member of the care staff who confirmed her involvement in this process and that this is a consistent approach taken in the unit in order to fully meet the needs of all the residents. A senior member of staff also reviews the care plans each month to make sure that each of the service users is being supported in the right way. The Inspector also interviewed one of the residents allocated care managers, from the referring agency, who confirmed to the Inspector his satisfaction with the care planning and review process for his service user living at the home. All of the people who live at the home usually go to see a local GP if they are not feeling well. The service users can see any local GP but most see the same one. The staff are good at writing down anything that happens if anyone becomes unwell. If any of the service users have an illness or something else is wrong with them then the staff do know what this is and how to help them to get the treatment that they need. If anyone needs to take medicine then the staff help him or her to do this. None of the service users can do this without help and the staff have written down why this is so on each of the care plans. The staff are very good at making sure that people take their medicines so that they can stay well. The staff make sure that no one can get hold of any medicine that they should not have and keep medicines locked away. The Inspector reviewed all the medication records for administered medication and did not find any errors in the documentation seen. The service users who spoke to the Inspector said that they feel as if the staff treat them well. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 & 15. The service users do feel assured that they may exercise choice and control over their lives, are able to maintain contacts with key people outside of the unit, and that their rights will be met by the staff team appropriately. EVIDENCE: During the course of this inspection visit the Inspector spoke to a number of residents in order to assess whether they found that their lifestyles experienced within the home and the support they receive from staff assists them in satisfying all their needs. All of the residents indicated to the Inspector (within the confines of their abilities) that they are happy and that are able to do the things that they wish when they want to. Care plans seen by the Inspector support the views reflected by service users that they are able to see their families and friends as they wish and this was also supported by the views of 2 visiting care professionals to the home who were also interviewed by the Inspector during the inspection visit. Staff interviewed by the Inspector told him that they assist service users to exercise choice and control over every aspect of their lives wherever possible. This was supported by evidence seen by the Inspector in a number of different areas. Choice over meals and menu selections is regularly offered to residents Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 13 and the Inspector was present during lunch and tea on the day of the inspection where staff offered residents a choice in what they wanted to eat. The Inspector also reviewed the minutes of recent residents meetings where there was a discussion about activities and trips being planned and where residents clearly indicated their preferences about what they wanted to do and that their wishes were evidenced to have been acted upon in the plans that were drawn up and agreed. The Inspector reviewed the menu plans set out for the next 3 weeks and found them to offer a varied and appealing diet. Residents interviewed were also asked how they found the food and they said that they enjoyed it and were able to choose alternatives if they did not want what was being offered. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 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 the following standard(s): 16 & 18. The service users can feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The home has clear guidance for staff about the procedures to be followed in either of these circumstances. EVIDENCE: The service users are given clear information about how to complain and what happens when they make a complaint. No complaints have been made to the home or to the Commission since the previous inspection. At a past inspection visit the manager of the home was asked to make contact with an advocacy organisation. This was to see if an independent advocate could be provided to any service user who does not have close contact with their family or friends. The manager did this and there is now clear information displayed in the hall with contact details about an advocacy service which residents can use if they need to. The Inspector reviewed the training provided to staff on the protection of vulnerable adults as well as the policies and procedures implemented in the home to ensure the protection of all the residents. 5 of the current staff group went on this training in 2005 and 5 more staff are awaiting training in 2006. The programme of training for staff has been devised to ensure that all of the staff are trained in protecting vulnerable people from abuse. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 15 Staff interviewed were well aware of the procedures in place within the home and seem to be good at making sure that all of the service users are protected from abuse (this means that the staff at the home do everything that they can to stop any of the service users from being hurt by someone else). They indicated to the Inspector their knowledge of what to do if they think that a service user is being hurt or abused by another person. None of the service users who spoke with the inspector said that they are being hurt by anyone else. They all knew what to do if they had a complaint to make. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24, 25 & 26. The service users can feel confident that they live in a safe, well maintained, hygenic and clean home. EVIDENCE: The Inspector visited all areas of the home on this visit in order to assess whether or not it provides a safe and well maintained environment for its residents. The standard of décor was seen to be reasonable, it is clean and bright and residents are able to choose the colours and decoration for each of their bedrooms. Residents were seen to have their personal possessions arranged as they wish in their bedrooms and when asked by the Inspector whether they are happy that they can choose to arrange their rooms as they wish they said they could. The communal areas such as the dining rooms and the lounges, bathrooms and toilets are also in a reasonable state of decoration and the overall impression provided is one of a well maintained home and clean home. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 17 The garden is accessible to the residents and is well kept and has a pleasant aspect looking over Lloyds Park. A recent report undertaken by the LFEPA in early April 2006 identified 4 requirements which needed to be met. The Deputy Manager confirmed with the Inspector that all of these requirements have now been met and the Inspector toured the building with the Deputy to check these areas and can confirm they have been satisfactorily met. It should be said that this represents a speedy and satisfactory response to the LFEPA’s report which is to be commended. The last Environmental Health check undertaken last year in May 2005 found no requirements to be met. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Staff recruitment and staff training policies and procedures are satisfactory to ensure that there is an appropriate sized staff group sufficiently skilled to meet the needs of the residents and to ensure that they are in safe hands. The management team must remain aware that when recruiting any new staff they do ensure that all the required background checks are always carried out otherwise this could place service users at risk. EVIDENCE: The Deputy Manager informed the Inspector that since the last inspection no new staff had been recruited. However at the last inspection there was an emphasis placed on the need that all prescribed pre- employment checks must be carried out if service users are not to be placed at risk. It therefore remains to be said that the management team must ensure that all the required background checks are always carried out when recruiting any new staff or otherwise this could place service users at risk. The Inspector saw the staff rota which shows who is working and when and was satisfied that staffing levels are adequate to meet the needs of service users at present. The Inspector reviewed all the staff files and all the information and records as set out in Standard 29 were seen on file and were satisfactory including up to Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 19 date CRBs, references, health checks and identification. Staff interviewed confirmed that they have a copy of their contract / terms and conditions of employment and copies were seen on the staff files. They were however unsigned and this should be addressed by the Manager. A comprehensive induction pack was seen to be in use for staff employed over the last year and evidence was seen by the Inspector that staff are asked to read the policies and procedures of the unit and to sign to say they have understood them and have had the opportunity to discuss them with their supervisor. The training files were reviewed by the Inspector in order to assess that staff are being supported, trained and competent to do their jobs. A variety of appropriate training is offered to all staff including training on fire, manual handling, food hygene, medication, health and safety, adult protection and NVQ training. The Deputy Manager advised the Inspector that 3 members of staff have now completed their NVQ training and the Inspector saw the appropriate certificates confirming their successful completion. 2 members of staff are currently being NVQ trained, 2 more members of staff are registered to be trained later this year and 2 members of staff will need to start the process for NVQ training. The Inspector is satisfied that if the current momentum is maintained the required levels of NVQ trained staff should be satisfactorily met. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 37 & 38. The management and administration of the home has continued to show signs of improvement in many areas. The management team should, however, remain mindful that they need to maintain this positive progress. Service users can feel confident that the home carries out all of the necessary health and safety checks to make sure that the house is a safe place in which to live. EVIDENCE: The registered manager of the home, Mrs Akuffo, is also one of the joint owners. Mrs Akuffo has previously been assessed as being a fit person to run the home at the time that she was first registered. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 21 It was required at a previous inspection that there needed to be a specific Quality Assurance system in the home. This is now in place and includes questionnaires that are given to service users and relatives who have contact with the home. The Inspector has suggested that in order to make this process more comprehensive and in order to cover those residents who do not have friends or family who can comment, questionnaires should be devised seeking feedback from the referring agencies so that their views can be taken into account during the process of service development and improvement. The Inspector was unable to see how the information gathered from the existing feedback questionnaires is used by the management of the unit in developing and improving services. This will be required in order to make most effective use of the feedback information. In the last inspection report concern was shown that minutes of service users monthly house meetings could be improved to show how the staff tell service users about the progress on development issues and matters of daily life. At this inspection the Inspector reviewed the minutes of the residents meetings held over the last 3 months. This demonstrated a clear improvement in communication with service users on these matters. Service users interviewed by the Inspector reflected in their discussions with the Inspector the improvement that staff have made to these meetings. It also seems that more residents have been attending these meetings than before which may indicate their feeling that the meetings are more worthwhile than they were. The home has continued to get better at carrying out staff supervision (Staff supervision is a time that each member of staff can meet individually with the manager to discuss how they are progressing in their work and to resolve any employment and training matters). There are now records in place that show that the home is on track to achieve the minimum required six staff individual supervision sessions in each calendar year. The following health and safety checks have been carried out in 2006: Gas Safety: 06/01/06 LFEPA fire safety: 6/4/06 Fire and security equipment: 26/4/06 Unit fire drill: 25/4/06 Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 3 3 Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP33 Regulation 24 Requirement The Quality Assurance system needs further development to gather views of all key stakeholders. A process for using the QA feedback info needs to be integrated into an annual service improvement plan for the unit. It is still necessary for staff to sign the records showing that they have read and understood the policies and procedures that are in use at the home. (This is an outstanding requirement from previous inspections) Timescale for action 27/07/06 2. OP37 18 (4) 27/07/06 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 OP1 Good Practice Recommendations As recommended at the previous unannounced inspection, the service user guide should be both updated and made more understandable for service users. DS0000025763.V291395.R01.S.doc Version 5.1 Page 24 Carlton House (30) 2. 3 OP4 OP4 & OP7 The home must continue to ensure that it keeps within its approved registration category by not admitting anyone who is outside of the agreed categories. Pre placement risk assessments and care plans must be completed for all new residents. Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Carlton House (30) DS0000025763.V291395.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!