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Inspection on 12/07/05 for Cecil Road (12)

Also see our care home review for Cecil Road (12) for more information

This inspection was carried out on 12th July 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.

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

What the care home does well

The service users have a homely and comfortable place in which to live. The staff in the home support the service users to exercise choice and control over their lives in order to promote their independence. The routines of daily living and activities are flexible and varied especially at weekends when service users have choice, as all three service users access day facilities during the week. The service users said that they are asked about issues that affect them in the home and are kept informed about any changes and events that take place. As it is a small home staff consult with the service users on a daily basis and with relatives who are closely involved with the service users. All necessary health care services are accessed for service users in order to meet their assessed and specialist needs. During weekdays each service user accesses activities at a day centre. Staff support them to go out in the evenings and weekends, for example, going to the cinema, restaurants, pubs as well as shopping and attending church. Visiting times are flexible and visitors are welcome at any reasonable time.

What has improved since the last inspection?

The home has recently been redecorated with new carpets and a settee acquired as part of the home`s refurbishment programme. The bedrooms as well as the kitchen and have also been redecorated giving the home a fresh appearance. This now provides the service users with an attractive and comfortable place in which to live. Staff have been encouraged to undertake training and most staff have completed NVQ level 2 training. At the previous inspection there had been six areas which the home had to improve. The manager has taken action on most of these areas which represents a very positive response to the findings of the previous inspection. One requirement remains outstanding which has been restated. The manager in the home emphasised that they are keen to work closely with the CSCI in order to raise the standards further at the home so that the service users have the best possible quality of life at Cecil Road.

What the care home could do better:

Areas where the home could be doing better were discussed and agreed with the manager. The medication policy and procedure must be followed by the staff. The involvement of the service users and relatives in the written care plans made by the home needs to be increased. A complaints log needs to be developed as discussed during the inspection.

CARE HOME ADULTS 18-65 Cecil Road 12 Cecil Road Ilford Essex IG1 2EW Lead Inspector Harina Morzeria Announced Inspection 12 July 2005 09:30 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. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cecil Road (12) Address 12 Cecil Road, Ilford, Essex IG1 2EW 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) 020 8514 8689 Mrs Veena Mehta Mrs Sumiran Sharma Mrs Veena Mehta CRH Care Home 3 Category(ies) of LD Learning disabilities (3) registration, with number of places Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Mild to moderate level of disability. Date of last inspection 02 March 2005 Brief Description of the Service: 12 Cecil Rd is a residential home registered to care for three younger adults with learning disabilities. The home is a terraced house in a residential area close to Ilford town centre, with good public transport links, a park and other community facilities. The house is an ordinary domestic property which is adequately maintained and appropriately furnished. All the service users occupy single bedrooms. Shared facilities include a lounge and a small dining area in the conservatory. A small garden is also available for the service users enjoyment. A bedroom is located on the ground floor as well as a toilet/ shower. There are two bedrooms upstairs plus a staff sleeping in room and a bathroom/toilet shared between the service users upstairs. The manager and staff ensure that the service users enjoy an active social life via membership of various groups and organisations. All of the service users attend day care services. The staff take the service users out on a regular basis to local pubs, cinema, restaurants as well as their chosen places of worship. Family and friends are welcome to visit at any time. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was an announced inspection and started at 9:30 a.m. and lasting for four hours. The inspector spoke to the manager and two members of staff. A tour of the home took place and a number of staff and care records were inspected as well as individual service user files. This inspection was arranged specifically to examine service user files and check requirements. At the time of inspection all service users were attending day-care and therefore the inspector did not have an opportunity to speak with them. However the previous unannounced inspection was carried out in the evening to speak to service users and staff and some of their comments are reflected in this report as well. What the service does well: What has improved since the last inspection? Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 6 The home has recently been redecorated with new carpets and a settee acquired as part of the home’s refurbishment programme. The bedrooms as well as the kitchen and have also been redecorated giving the home a fresh appearance. This now provides the service users with an attractive and comfortable place in which to live. Staff have been encouraged to undertake training and most staff have completed NVQ level 2 training. At the previous inspection there had been six areas which the home had to improve. The manager has taken action on most of these areas which represents a very positive response to the findings of the previous inspection. One requirement remains outstanding which has been restated. The manager in the home emphasised that they are keen to work closely with the CSCI in order to raise the standards further at the home so that the service users have the best possible quality of life at Cecil Road. 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. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_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 Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_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) 1, 2, 3 ,4 and 5 A Statement of Purpose and Service Users Guide are available providing service users and prospective service users with details of the services the home provides enabling an informed decision about admission to the home. Prospective service users’ individual needs are assessed and a new service user would only be admitted on the basis of a full assessment undertaken by people who were trained to carry out assessments. New service users are informed that they would only be offered a place in the home if they can meet their needs. New service users are given an opportunity to visit the home and stay there for a trial period, before they decide if they want to live there permanently. Each service user has an individual contract or statement of terms and conditions with the home. EVIDENCE: At the time of inspection the inspector was shown a copy of the Statement of Purpose and a Service Users Guide which includes detailed information about the services the home can provide. There have been no new admissions to this home since it opened. However, the inspector was satisfied that the manager would carry out an assessment of a prospective service user’s needs prior to offering a place in the home. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 9 The Service Users Guide and the terms and conditions state that service users will be given an opportunity to visit the home and stay for a trial period before deciding whether they wish to stay permanently. There was evidence on service users’ files that service users needs are assessed regularly and care plans are updated if their needs change. Family members and service users’ involvement needs to be increased when care plans are drawn up in order to ensure that they are fully consulted and involved. See recommendation. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 and 10 Each service user has an individual care plan which outlines the service users’ needs and personal goals. Service users are consulted about their lives and encouraged to make independent decisions as far as possible. Appropriate risk assessments are in place for activities undertaken by the service users in order to promote their independence. Service users know the staff will handle any personal information about them confidentially. EVIDENCE: As stated above, each service user has a care plan, which outlines the service user’s individual needs and how these will be met. The inspector looked at the care plans for all three service users living in the home and noted that each plan outlines the service user’s needs and how these are met. The inspector spoke to all three service users at a previous inspection when they said that they are given choices and are asked by staff about what they would like to do on a daily basis. All the service users know who their key workers were and said that they would talk to them or the manager if they had any problems. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 11 There are comprehensive risk assessments for all the different activities service users take part in and the service users are supported by staff to carry out their chosen activities, within this framework. Daily records show that staff write what the service user has done daily, reflecting how their needs are being met. Staff spoken to stated that they are required to sign a confidentiality statement which requires them to maintain privacy with regards to any information shared by service users and only divulge this with any professionals on a need to know basis. Any discussions or consultations to be held with service users are held in their bedrooms in privacy. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 Service users have opportunities for personal development and are able to take part in age, peer and culturally appropriate activities. Service users are encouraged to engage in appropriate leisure activities within the local community. Their rights are respected and responsibilities are recognised in their daily lives. Service users enjoy their meals and are asked on a daily basis to choose from the menu, which they have already agreed. EVIDENCE: The daily routine is set by the activities that the service users are involved in, largely at the day centre during weekdays. However, the weekend routine is flexible when the service users are given choice as to what activities they want to access. Service users choose to go shopping locally where they are known by many of the shopkeepers or to the town centre with staff as well as to the library, park and other leisure activities for example, eating out, going to the pub or to the cinema. Service users are also encouraged to access other activities organised by the various clubs they belong to, for example, the Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 13 Gateway club. On Sundays staff take the service users to church if they wish to go after which they have a Sunday lunch and then relax. All service users have holidays planned for the summer. This shows that service users are consulted and their routines promote individual choice and freedom of movement. One service user’s parents are closely involved with her and the other service users, visiting frequently. They are hence able to guide and participate in their lives closely and have a lot of input into what happens in the home. The dietary needs of service users are well catered for with a balanced and varied selection of food available that meets the service users tastes and choices. The service users are encouraged to assist staff to prepare meals and help to clear up in order develop their independent living skills. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users receive personal support in the way that they prefer and require. The daily record is assured that the service users’ physical and emotional health needs are met appropriately within the home. The implementation of the medication procedures in this home need to be improved for service users’ safety. EVIDENCE: Through case tracking and inspection of daily records and discussions with the staff and the manager, the inspector is satisfied that the service users’ health is adequately monitored and any problems identified are dealt with quickly by taking the person to the doctor in the first instance. Each service user has a designated key worker, who ensures that they receive the support and advice they need quickly. The medication policy and procedures are in place and staff have received training regarding the administration of medication. A requirement was made at the previous inspection regarding the recording of medication administration. However the home continue to have difficulties obtaining MAR sheets from the pharmacist. Upon checking the storage of medication, the inspector noted that unused medication had not been returned to the pharmacist with a number of out of date items also stored in the cupboard. This clearly puts the service users at risk of harm. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 15 The manager is required to ensure that the home’s medication policy and procedure are followed by the staff for the receipt, recording, storage, handling, administration and disposal of medicines. This includes appropriate provision and use of MAR sheets. See requirement. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has a satisfactory complaints policy and procedure which service users and their representatives are aware of. All the staff working in the home have received training in adult protection/abuse awareness to ensure a proper response for reporting any suspected or witnessed abuse. EVIDENCE: The home have a complaints procedure which the service users and their representatives are aware of and it is also pinned up on the notice board in the hallway at the entrance to the home. The inspector was informed that there were no complaints recorded and that staff quickly resolve any dissatisfaction before it results in a complaint. The inspector recommends that the manager develops a complaints log book where all complaints/ dissatisfactions are logged, showing how these are resolved within written timescales. See recommendation. There is a written policy and procedure for the protection of vulnerable adults and all newly recruited care staff receive basic abuse awareness training during their induction followed by attendance on a more detailed course when available. The staff spoken to as part of the inspection process confirmed that they have received training regarding this and were clear as to their responsibilities to report any potential abuse and what the reporting lines should be. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 17 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, 25, 26, 27, 28, 29 and 30 Service users live in a homely and comfortable environment. Bedrooms, communal areas, toilets and bathrooms meet their needs and promote their independence. Shared spaces are sufficient for the numbers of people living in the home. Specialist equipment is available for those service users who require it. The home is clean and hygienic. EVIDENCE: The house is in keeping with other properties on the street and a tour of the promises showed that it is decorated and furnished in a homely manner. All the areas in the home have recently been repainted and new settees have been acquired. All the service users occupy single rooms, which are well decorated and contain their personal possessions, reflecting their individual choices and personalities. The service users were spoken to at the previous inspection when the home had been just redecorated and all of them said that they liked their rooms and were comfortable and safe in them. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 18 One of the service users who uses a wheelchair is accommodated in a large single room downstairs. She has access to a downstairs toilet/ shower facility which enables her to be independent. Recently a self propelling wheelchair was acquired for her to maximise her independence. All parts of the home seen were clean and tidy and so were the bathrooms and toilets. There is a small garden at the back of the house accessed via the dining area/conservatory for the service users enjoyment. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 19 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 All the staff have job descriptions which clearly outline their roles and responsibilities. Staff are competent and sufficiently experienced to carry out their task. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the service users. The home have a recruitment procedure for staff which is robust and provides safeguards for people living in the home. EVIDENCE: The home has a relatively stable staff group. In discussion with the staff, it was evident that they fully support the main aims and values of the home. There is a close professional relationship between the staff and the service users. The staff can understand, meet and review the needs of the service users. The service users benefit from the close attention paid by the staff to meet their health needs. Staff files showed that they had done training in essential areas, such as food hygiene, health and safety, administering medication, and adult protection. Most staff have completed NVQ level 2 training and one member of staff is on an NVQ level 3 training course. The recruitment procedure is being followed, and documentation showed that Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 20 All staff have been CRB checked, with two references available, ensuring protection for service users. As a result the service users get a good quality of support and care from the staff at the home. Staff confirmed that they receive supervision and support from the manager on a regular basis, which they find helpful when carrying out their tasks. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 21 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 being managed well by the current manager, who is sufficiently experienced, qualified and competent to run the home and meet its stated purpose, aims and objectives. The home reviews aspects of its performance through a programme of selfreview and consultations, which include seeking the views of service users, staff and relatives. EVIDENCE: The current manager is also joint proprietor of the service and has been managing the home since it first opened. She has sufficient experience of managing the home and provides a safe environment for the service users. She is in the process of completing her NVQ level 4 qualification. The health, safety and welfare of the service users are met by the staff working in the home. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 22 Staff spoken to said that they receive support and encouragement from the manager, which helps them to carry out their jobs competently. Questionnaires were sent by the home to service users and their representatives to seek their views about the quality of the service. Feedback received showed a high level of satisfaction. The inspector recommends that staff and other professionals are also consulted as part of this process. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 23 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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 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 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cecil Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 x G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 24 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 20 Regulation 13 Requirement The registered person to ensure that the homes medication policy and procedure is followed for the receipt, recording, storage, handling, administration and disposal of medicines. This includes appropriate provision and use of MAR sheets by the staff. Timescale for action 30/9/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 39 8 22 Good Practice Recommendations The inspector recommends that as part of the homes quality monitoring staff and other professionals are also consulted. Family members and service users’ involvement needs to be increased when care plans are drawn up in order to ensure that they are fully consulted and involved. A complaints log book to be developed where all complaints, no matter how minor, are recorded, showing how these are resolved within written timescales. Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU 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 Cecil Road G55_S0000025892_Cecil Road_ V233952_120705_Stage 4.doc Version 1.30 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!