Inspection on 12/05/05 for Casarita

This inspection was carried out on 12th May 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

Casarita 02/03/09

Casarita 20/03/07

Casarita 22/12/05

Casarita 25/01/05

Casarita 19/07/04

Casarita 18/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Casarita 270 Fakenham Road Taverham Norwich NR8 6AD Lead Inspector Lella Andrews Announced 12 May 2005 14:00 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Casarita Address 270 Fakenham Road Taverham Norwich NR8 6AD 01603 279222 01603 279529 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) Jeesal Residential Care Services Limited Mrs Amanda James Care Home 7 Category(ies) of Learning Disabilty (7) registration, with number of places Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25 January 2005 Brief Description of the Service: Casarita is a modern, two storey detached house with a single storey annexe. The Home stands in its own grounds on the main road into Norwich in the suburb of Taverham. It is situated within a few minutes walk of shops, post office and a public house. The Home has two vehicles. Accommodation is provided for up to seven adults with a learning disability, some of whom demonstrate challenging behaviours. All of the service users have their own bedroom and the majority of these have ensuite shower and toilet. One of the service users lies separately in the annexe and has a dedicated staff team. The Home is owned and managed by Jeesal Residential Care Services Limited. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was announced and took place between 2pm and 6.50pm on Thursday 12th May 2005. A tour of the communal areas of the Home was undertaken. Three tenants spoke briefly to the Inspector, one with the assistance of the member of staff using sign language. The Inspector spoke to a group of staff and tenants as well as talking to one member of staff on an individual basis. The Manager provided information throughout the Inspection, both verbally and in the form of records. The Inspector received four completed comment cards from relatives which all contained positive comments about the service provided to their relative. Two completed comment cards were received from health professionals and these also contained positive comments about the service provided at the Home. What the service does well: The Home is well managed and the Manager and the Deputy Manager work well as a team to provide leadership to the staff team. The organisation provides support from the Behaviour Support Manager and Support Services Manager as needed. The staff team are enthusiastic about their work with the tenants and have a good knowledge of the individual needs of the tenants. Staff are keen to provide a good standard of care and to ensure that tenants are able to access community facilities. Communication is given a high priority and staff receive training with regard to sign language to meet the needs of two of the tenants who have hearing difficulties. The assessment process for new tenants is managed well with appropriate support provided to the prospective tenant and their relatives with regard to visiting the Home prior to making a decision. Relatives and visiting professionals are made to feel welcome at the Home. An example of this is a comment within a completed comment card: “ there is always someone there to make a cuppa and to make us feel welcome when we visit” Several of the staff team have undertaken training with regard to Person Centred Planning which is a process of enabling the tenants to put together, with support, their own care plan and plans for the future. This work has started with two of the tenants. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 6 Staff receive a good level of training with regard to a range of relevant areas. This includes effective induction training. 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. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 4 The assessment process is thorough and provides good information with which the prospective tenant, their relatives and the Manager can make a decision about whether the Home can meet the individuals needs. EVIDENCE: The majority of the tenants have lived at the Home for over two years, with one tenant having moved into the Home within the last four months. The care plan for this tenant includes a detailed assessment with evidence of information having been gathered from all those involved in the tenants life. The Manager was fully involved in the assessment process. The assessment process included regular visits to the Home by the tenant and their relatives/representatives prior to making the decision to move there. This was confirmed by the other tenants living at the Home. The Manager and the staff are clear about the range of needs that can be met at the Home and also have a good understanding of the needs of the tenants. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10 The care plans provide detailed information to staff about how to meet individuals personal, health and social care needs. The tenants feel that the staff treat them with respect and that their privacy is respected. They also feel that they are consulted about the general running of the Home and issues that affect them personally. EVIDENCE: The care plans are detailed and cover all aspects of the tenants life. Two of the care plans were seen and these contain clear assessments of individual needs with care plans written based on the assessment information. There is evidence of regular reviews taking place and of the tenants having been involved in this process. The tenants are aware of their care plans and know that they can see them at any time. The care plans contain detailed risk assessments for a range of situations individual to each tenant. Staff are aware of these risk assessments. It was noted that a situation of which staff were aware was not recorded in enough detail and a recommendation is made with regard to this. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 10 The Manager advised that staff will shortly receive training with regard to using the organisations revised care plan format. The Inspector has seen this format and feels that this change will be a positive one as the new formats provide information in a more clear and easy to read style. Several staff have received training with regard to Person Centred Planning which is a process for enabling tenants to put together, with assistance as needed, a plan which is personal to them and which they have control over. Two of the tenants have started to put together their plans and the Manager advised that they intend to have a social event shortly at which they will explain the process to relatives. All staff will receive the appropriate training by the end of this year. Staff are aware of the importance of alternative methods of communication. Two of the tenants have hearing problems and one is very proficient in the use of signalong and so it is important for staff to have these skills also. All staff, apart from two new members of staff, have received signalong training. Staff advised that they regularly practice these skills amongst themselves and a new member of staff advised that they have been taught some signs by other staff. The Manager does not ask staff to work with the tenant who uses sign language unless they have received appropriate training. The fire procedures are displayed in symbol format around the Home. The poster notifying tenants and staff of the Inspection had also been translated into symbol format and was displayed around the Home. Tenants hold their own keys unless there is a recorded reason why this should not be so. Tenants meetings minutes show that the tenants are kept informed of any situations affecting the household and that their views are sought on a range of issues. Staff knock on tenants doors and wait for an answer prior to entering. Staff are aware of the importance of respecting the privacy of the tenants. The completed comment cards from health professionals and relatives all said that they are able to see tenants in private. Staff are also aware of the importance of confidentiality. All staff sign a statement to confirm that they have received a copy of the confidentiality policy. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, and 16 Tenants are encouraged and supported to take part in a range of activities within the local community. Relatives are made to feel welcome and are encouraged to visit tenants. Tenants rights are respected and the staff encourage tenants to develop and maintain skills with regard to independence. EVIDENCE: The care plans contain information relating to individual tenants personal development needs and to their social needs and preferences. Tenants are encouraged to develop skills with regard to household tasks and are all involved in tasks such as cooking, laying tables, hoovering etc. This involvement is detailed within their care plans and also on a rota displayed in the kitchen. Tenants told the Inspector that they like to be involved in the running of the household. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 12 Three of the tenants attend formal day services five days per week, one tenant attends part time and three of the tenants do not attend any formal day services. Tenants not attending formal day services are supported by staff to access community facilities. These include adult education classes and more informal leisure activities as well as shopping for personal items or food shopping for the Home. The tenant who lives in the annexe has dedicated one to one staffing during the day. The staffing situation has improved since the last Inspection and tenants and staff all advised that there are enough staff at weekends and during evenings for tenants to take part in social activities away from the Home if they wish to. These include ten pin bowling, pub meals, snooker, visits to the coast and other places of interest. The tenants meeting minutes show that the choice of activities is always discussed and that arrangements are made to enable activities to take place whenever possible. Tenants told the Inspector about their plans for forthcoming holidays. The Home had recently developed some outbuildings into an activity room but unfortunately this had been damaged by fire. The damage has now been put right and the room is available for tenants to use for art and craft activities as well as being an additional room to use if tenants wish for time away from the main house. The completed comment cards received from relatives all said that the staff always make them feel welcome. This was confirmed by the Homes own quality assurance questionnaires which were completed by relatives. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 21 Tenants receive personal support in the way that they prefer and which meets their needs. Tenants physical and emotional health needs are assessed, planned for and met. Tenants who have physical or emotional ill health are treated with respect and appropriate health professionals are involved. EVIDENCE: The staff are completing a revised format for recording information about the health needs of the tenants and this is more detailed and informative than the previous format. There are records of health appointments as well as appointments with dentists, audiologists and opticians. Staff are knowledgeable about the individual health needs of the tenants. One of the tenants was unwell on the day of the Inspection and staff supported them in a kind and appropriate manner. The tenant said that the staff had been very supportive when she had needed hospital treatment the previous evening. The comment cards completed by visiting health professionals stated that staff demonstrate a clear understanding of the care needs of the tenants and that they communicate clearly with the health professionals. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 14 One of the tenants has experienced a recent period of emotional ill health and the staff have worked hard to support them in a positive and respectful way whilst trying to reduce any effects on the other tenants within the Home. The organisations Behaviour Support Manager has been involved with assessing and planning care for two of the tenants. He has also provided training and support to the staff. The Home has recently introduced a key worker system which both staff and tenants told the Inspector about. One of the benefits of the keyworker system should be that there is an identified person to ensure that all routine appointments such as dentists, opticians etc are made and kept. The staff are aware of the differing needs of the tenants living at the Home and are able to describe how best to meet individual needs with an emphasis on enabling tenants to make their own choices. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Neither of these standards were looked at during this Inspection EVIDENCE: N/A Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 28 and 30 The tenants live in a homely, comfortable and safe environment. The Home is clean and hygienic. There are several communal areas which enables tenants a choice about where they spend their time. EVIDENCE: A tour of the communal areas of the Home, including the garden and activity room, was undertaken. All areas of the Home were clean and hygienic. The rooms are all decorated and furnished in an attractive and homely style. The Home has a large comfortable lounge with enough room for all tenants to sit if they wished to. The smaller lounge has recently been redecorated and had new lighting. This room is now much more comfortable and homely and the tenants are pleased with the improvements. The dining room is due to have new lighting and to be redecorated also. The tenant living in the annexe has their own lounge/dining room which is decorated and furnished to their own preference. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 17 The activity room has been refurbished following the fire and provides a good space for tenants to use. The Manager advised that there are plans for the shed next door to be altered into toilets and a kitchen area so that tenants using the activity room do not have to go back to the house for these facilities. Another of the outbuildings has been converted to an office for the Manager to use. This is large enough for meetings to take place which will mean that the dining room will not have to be used for meetings. Staff and tenants said that they are in the process of deciding what changes to make to the garden to make it more attractive and easier to use. Work has been done to improve the parking area at the front of the Home. The garden attached to the annexe has also been attended to. The Manager advised that there are plans to improve the access to the front door and to improve security by moving the fence and gates. Risk assessments are carried out with regard to the safety of the tenants and staff who live and work in the Home. Individual risk assessments indicate that the kitchen is kept locked when no staff are present, however, tenants are encouraged to use the kitchen with staff support. Tenants have free access to all other communal areas of the Home. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 and 36 Tenants are supported by an effective staff team who receive appropriate training and support to carry out their roles. Recruitment procedures are rigorous in order to protect the welfare of the tenants EVIDENCE: Staff are clear about their own roles and that of others within the team. They were seen to support the tenants in a positive and respectful manner. Tenants said that the staff are kind. Staff received effective induction which provides them with good information about the individual needs of the tenants as well as information about the organisation and the standards expected of them as a member of the team. New staff said that the induction had been extensive and appropriate to their needs as a new member of staff. The training record shows that all staff, except for two new members, have received all of the mandatory training expected by the organisation. The new members of staff have received some of this training and have dates to attend the remaining. The majority of staff have also attended training which will help them to meet individual tenants needs, such as Autism awareness, Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 19 awareness of behaviour assessment and support planning, epilepsy. As already mentioned, additional training is provided during staff meetings with regard to specific issues relating to individual tenants. Two of the recruitment files were seen and these contain the necessary checks ie. Criminal Records Bureau disclosure, references and proof of identity. The Manager is aware of the need for diligence when recruiting staff and has received training with regard to this. The Manager has recently carried out annual appraisals for staff and has commenced a programme of regular staff supervisions. This has only recently been implemented and so will be looked at again during future Inspections. Staff said that they are able to discuss issues with the Manager or deputy manager whenever they wish to. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41 and 42 The Home is well managed with the leadership approach being one of including the tenants in decisions affecting them. The staff are aware of the policies and procedures of the Home which promote the tenants rights and best interests. The health and safety needs of the tenants are given a high priority with risk assessments being undertaken and steps taken to reduce/remove identified risks. EVIDENCE: The Manager of the Home is currently undertaking NVQ Level 4 training and has also undertaken management skills training provided by the organisation. The Manager and deputy work well as a team and provide good support to the staff. Staff advised that they feel able to discuss issues with them if they need Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 21 to. The organisation provides an on call system for out of hours support and staff advised that this is effective and provides good support when needed. A new member of staff advised that they have received very good support form the whole staff team during their induction. Regular team meetings take place at which staff are encouraged to express their views. The Home has further developed their internal quality assurance process during the last year. There are several ways in which regular monitoring takes place of the service provided eg, monthly review of care plans, tenants meetings, annual questionnaires to relatives and visiting professionals, health and safety checks. These have now been brought together within the annual development plan for the Home. The Home uses the organisations policies and procedures which are extensive and are written with the aim of promoting and safeguarding the needs and choices of the tenants. The staff are aware of the policies and procedures and are required to read these on a six monthly basis. The written records seen during the Inspection were clear and staff have a good understanding of the records that they are required to keep. There is one recommendation made with regard to ensuring that risk assessments are detailed and contain sufficient guidance to staff. The records relating to fire safety were seen. These are up to date and show that regular fire drills take place. It is recommended that the names of staff taking place in fire drills are recorded so as to ensure that all staff receive the appropriate training. It is also recommended that certificates are obtained when fire safety equipment is serviced. There are no outstanding requirements from the most recent Fire Officer and Environmental Health officers inspections. Weekly health and safety checks take place for a range of situations. Records are kept of any work that is required to reduce risks. Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 3 4 x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 2 3 x Standard No 31 32 33 34 35 36 Score 3 3 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Casarita Score 3 3 x 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 4 3 3 x I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 23 no 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 N/A 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. 2. 3. Refer to Standard 9 42 42 Good Practice Recommendations It is recommended that all written risk asessments provide clear guidance to staff about how to manage the risk It is recommended that the names are recorded of staff taking part in fire drills It is recommended that certicates are obtained when fire safety equipment is serviced Casarita I55 s27656 Casarita v219193 120505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Rd Norwich NR3 1YF 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 Casarita I55 s27656 Casarita v219193 120505 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. 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