CARE HOME ADULTS 18-65
Channel View 42 Albert Road Clevedon North Somerset BS21 7RR Lead Inspector
Melanie Edwards Key Unannounced Inspection 10th December 2007 09:15 Channel View DS0000008133.V350279.R01.S.doc Version 5.2 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 Channel View DS0000008133.V350279.R01.S.doc Version 5.2 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 Adults 18-65. 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. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Channel View Address 42 Albert Road Clevedon North Somerset BS21 7RR 01275 341199 0117 9709301 max@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust 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) Ms Kathleen Edwina Paramore Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (8) Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate up to 8 persons with mental disorder aged 18 years and over 22nd June 2006 Date of last inspection Brief Description of the Service: Channel view provides care for a range of service users with enduring mental health issues. The Home offers homely accommodation in Clevedon, and is a short walk from a range of facilities and shopping areas. Channel View is a care home, providing care and support for up to eight people with long-term mental health needs. The manager and a team of care staff support residents. The Home is a three-storey building conveniently placed close to the centre of Clevedon and is close to local amenities, and the shops. There are eight bedrooms, two communal lounges, a kitchen/diner, bathrooms and toilets on all three levels. There is also a sleep-in bedroom for staff members on the ground floor. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. We, (the Commission) met six residents to find out their views. We met three support workers to find out about their roles and responsibilities, training needs, and how they assist and support residents. The staff were also observed assisting residents with their needs. A range of records relating to the day-to-day running and management of the Home were inspected. Two resident’s care records and care plans were inspected. The ‘AQAA’ (an annual quality assessment document that all Homes are required to complete) has been used to help form the judgments in the report. The environment was viewed throughout. The Home was operating within the required conditions of registration set down by the Commission. The conditions of registration detail the type of care and the needs of residents, and the numbers of residents who may stay at the Home. What the service does well: What has improved since the last inspection? What they could do better:
Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 6 The registered provider must ensure that a re-assessment of two residents needs is carried out. This is because evidence from the Home suggests the residents concerned have nursing needs. Two residents risk assessment records need to be updated. This is because both residents risk assessments were written when they were at another Aspects and Milestones Trust Care Home. Risk assessments need to be suitable for the Home people are living in. The medication fridge must be made secure with a suitable locking device. The admission criteria should be updated, as a resident has been admitted with needs that the Homes own admission criteria states they cannot meet. 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. The summary of this inspection report can be made available in other formats on request. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Channel View DS0000008133.V350279.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs are generally being assessed and are met by the Home. However two residents needs require re-assessing to make sure they can have their needs met by the Home. The necessary information is available to help residents to understand the service provided by the Home. EVIDENCE: Residents’ needs are generally being assessed and are met by the Home. However two residents needs require re-assessing to make sure they can have their needs met. The necessary information is available to help residents to understand the service provided by the Home. To check on how prospective residents can find out about the Home a copy of the service users guide and statement of purpose were read. The guide includes information about the service provided, the qualifications of the staff employed, and the accommodation. The philosophy of the Home and how the service aim to meet residents needs was also included. A copy of the complaints procedure is also given to all residents.
Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 9 A copy of the statement of purpose was looked at to find out how the service meets its aims and objectives. A copy of this document, and the service users guide is kept in the entrance hall for residents and visitors to read. The statement of purpose includes all of the relevant information about how the Home is run. This includes the staffing levels, and staffing structure, as well as the type of care that will be provided. To find out how well residents’ needs are assessed two assessment records were looked at. An assessment of the physical, mental health and social needs has been carried out. There was also information recorded about the resident’s views of their care. Included in the assessments were the likes and dislikes of the resident. However, based on written evidence in both resident’s records, and discussions with all of the staff including the manager (by telephone), the evidence suggests the residents have nursing needs. To make sure that both people’s needs are met, a re-assessment of both residents needs must be done, with the involvement of both residents. This is to show how the residents are going to receive all of the care they need. We looked at the admission criteria to find out how the Home decided on who it can care for, and if they can meet peoples needs. The admission criteria clearly sets out the type of needs that the Home can meet and how they will do this. However it would be beneficial for prospective residents and the Home if the current admission criteria were revised and updated. This is because one resident has been admitted with needs that the Homes own admission criteria states it cannot meet. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents needs are assessed and their care plans reflect how needs are met. Residents are supported to make decisions and to take risks in their daily lives. However risk assessments records are not up to date. EVIDENCE: To find out how well residents are being supported to meet their needs two care plans were read. There was a plan of care for both residents showing how to address their mental health, physical and social, needs. The care plan clearly and simply sets out what the persons needs and wishes are, and how best to support them A personal history has also been written with the involvement of the resident concerned. This includes information about their physical and mental health history and information about the person’s family and friends. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 11 There was evidence written in the records that staff had included the wishes and opinions of the resident. There was also evidence that the care plans had been evaluated and updated on a regular basis. The support workers helped residents in a friendly and calm manner. They were meeting the resident’s needs in the manner stated in the care plans. Three residents spoke positively about how the staff help them, residents said the staff were kind and helpful. Residents go out with staff on regular basis and attend a range of social and therapeutic activities. Two residents went out to the shops in Clevedon. This is a good way for residents to be able take risks in their daily lives. There was information in the care plans about potential risks the person may face, and any risks from particular activities that they take part in both in and out of the Home. However two residents risk assessment records that were seen had been written when both residents were living in another Care Home. The risk assessments must be current for the Home people are living in. There was information written in resident’s records that showed staff were aiming to support them to maintain their independence in their daily living. Residents were seen getting up at various times during the morning, which helps to demonstrate how their different preferences are respected. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are well supported to take part in a range of appropriate activities. Residents are supported to be a part of the community and to have personal relationships. Residents are provided with a well-balanced and varied diet. EVIDENCE: Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 13 Residents are well supported by the staff to go on regular trips out of the Home, and residents seem to gain satisfaction and enjoyment from these opportunities. Residents go out for coffee, as well as to nearby pubs, and other social venues thereby helping to ensure a varied and fulfilling life. There was information recorded in the two residents records that confirmed they regularly attended a range of therapeutic activities. One resident was out for the morning at a social event they take part in on a regular basis. The Home had been decorated with a Christmas tree and Christmas decorations. Residents said how much they were looking forward to Christmas Day. The Home has a very open policy for receiving visitors. Some residents have friends and family who come to the Home to see them. Residents also go out to meet family on occasion. These are good examples that show residents are supported to keep contact with friends and family. The Homes menu was looked at to see if residents have a varied and well balanced diet. Residents are involved in the menu planning, and can choose what dishes they like. The choices were nutritionally well balanced, and varied. The lunchtime meal was cauliflower cheese and cold meat, and chipped potatoes or a vegetarian alternative. The residents said the food they have is ‘ very nice ’, and ‘ good ’. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being supported with their needs in the way preferred by them, and their needs are being met. Residents ’ medication is being administered and disposed of safely. However the procedures for storage of medication are only partly safe. EVIDENCE: A Psychiatrist and team support residents with their mental health needs. There was information seen in residents care records from the psychiatrist, who gives advice and support to residents with their particular needs. There are care reviews held involving residents, staff from the Home and the Psychiatrist and team. All residents are registered with a local GP Practice to support them with their physical health care needs. There was information in care records about residents preferred day-to-day routine, as well as their particular likes and dislikes in their daily lives. This
Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 15 helps make sure residents needs are met in the way that is preferred by them. The support workers were clearly familiar with the information in care plans, and how best to support residents with their care needs. There was information in daily records to show staff monitor and observe the health of residents and call the doctor, if they were concerned about the person. The procedures and systems in place for administration, storage and disposal of medication were checked to monitor if the systems are safe. The medication administration charts of three residents were inspected. There was a photograph of the person maintained with each record. This should ensure medication is administered correctly to the person named on the chart. The medication administration charts were legible, up to date, and contained the signature of the dispensing member of staff. This demonstrates residents’ medication is administered safely. The reasons for any omissions had also been written on the charts. All staff who give out medication do regular training to enable them to do this safely. The stock of medication held in the Home was satisfactorily organised. However the medication fridge is not secure, specifically a lock needs to be fitted on it on. Medication no longer needed is being returned to the pharmacist. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ views are listened to, and acted on by the Home There is a procedure and there is staff training in place to protect residents from the risk of abuse or harm. EVIDENCE: The complaints book record was looked at to see how residents’ complaints are responded to. The complaints book showed that there had been no complaints recorded since before the last inspection. Each resident has been given a copy of the procedure to make a complaint and this includes the contact details for Aspects and Milestones Trust as well as our details. This means residents have the information they need to complain about the service. There are regular `residents meetings’ held and this is a good opportunity for residents to complain if they need to. There is a `protection of vulnerable adults’ procedure to protect residents and to guide and support staff in the event of an allegation of abuse. The majority of staff have done training on issues related to abuse in the last twelve months. Training records that were seen confirmed staff do regular Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 17 training on this subject. This helps to demonstrate how residents are protected from the risk of harm or abuse. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a Home that is suitable for their needs and lifestyles and promotes their independence. The Home is clean and satisfactorily maintained. EVIDENCE: Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 19 Channel View Care Home is an older building in a quiet residential area in Clevedon. It is close to local shops, a library, a Church, and a pub. Residents use these local amenities regularly. The Home was clean tidy and satisfactorily maintained in all areas that were seen. There are two lounges, and an open plan kitchen and dining room for the residents to use. This is beneficial as this helps ensure residents can maintain their privacy and personal space if they so wish. Residents looked relaxed and comfortable in their surroundings. The bedrooms have been personalised with personal possessions. There is furniture and fittings provided, including a wardrobe a comfortable chair, a bedside cabinet and a chest of drawers in each room. There are photographs in some rooms that help create a more personal feel to rooms. All bedrooms have sinks in them and two bedrooms have an ensuite bathroom. There are also two main bathrooms ,one with a shower the other with a bath. The kitchen is on the ground floor leading onto the dining room. Residents use the room to prepare drinks and snacks with the support of staff if needed. This helps to demonstrate residents live in a relaxed Home where they can be independent if they wish to be. There is a laundry room on the ground floor, with a washing machine and one tumble dryer. Residents use the laundry to wash their own clothes with staff support if needed. This is a good way for residents to maintain independence in their daily living activities. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 20 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,36. Quality in this outcome area is good. Residents are supported by a sufficient number of competent, qualified staff who are supported and supervised in their work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To see if the Home follow safe recruitment practises a Regulation Manager from our office carries out regular checks on staff employment files at the Trust head office. Based on the evidence from the visit there is good evidence that all staff complete a Criminal Records Bureau offences check prior to employment. These checks are a safeguard to protect vulnerable residents. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 21 The staff duty record for shifts in December 2007 were looked at to review the number of care staff on duty to support residents to meet their needs. There is a minimum of two staff on duty for a day shift, consisting of two care staff, and one staff member at night. An extra staff member will also work on several days in the week to support residents. Based on the evidence from the inspection the number of staff on duty at any time is the minimum number necessary to ensure peoples’ needs are being met. The support workers looked calm and relaxed when carrying out their duties. All of the residents were observed being well supported by the support workers on duty. The acting manager provides the staff with regular structured supervision sessions to assist them in their work and to help them to understand residents needs. All of the staff said that the acting manger supervises them, and regularly checks on the standard of work of all staff in the Home. The staff training records were seen to find out if staff do regular training to help them keep up to date in their knowledge of residents and their needs. The training records demonstrated staff had attended training relevant to the needs of residents. This should help the staff are well-trained and knowledgeable, so that they can meets residents’ needs. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 22 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,41,42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ live in a Home that is well run. The health and safety of residents and staff is satisfactorily protected. EVIDENCE: The new acting manager is a qualified mental health nurse. Her career record shows that she has experience working with people who mental health needs. She is not yet registered with us as the manager of the Home, although an application is going to be made to us. The residents who spoke to the inspector were positive about the acting manager who they said was, ‘ very kind ’, and ‘very helpful’. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 23 Residents ’ records are kept in a locked metal cabinet in the office. The care records and records that were seen relating to the running of the Home were satisfactorily written, legible, up to date, and satisfactorily maintained. This helps to demonstrate confidentiality is being protected, and shows legal records required for the running of the Home are in order. The monthly monitoring visits of the Home that must be done by a representative of Aspects and Milestones Trust are being undertaken as required by law. There are records of these visits being sent to us. The records that have been seen, demonstrate that the designated individual responsible for the visits spends time consulting with people and their representatives and observing staff. Residents said that they know the senior manager who does the Regulation 26 visits very well, and he is, ‘ a very nice manager ’. The Home looked safe and satisfactorily maintained in all areas viewed. There are Aspects and Milestones Trust staff who are designated health and safety representative and they do regular health and safety audits of the environment. Staff in the Home he also do out regular health and safety checks of the environment, to help ensure the Home is safe and satisfactorily maintained. Staff do regular training in health and safety matters including first aid. This should help protect residents’ health and safety if staff are knowledgeable and trained in health and safety principles and practices. All staff do food safety training to help them maintain their understanding of how to handle and cook food safely. High-risk foods, such as meat, eggs, and fish are temperature probed before serving to demonstrate that they have reached above the minimum safety guidance temperature. The fire logbook record confirmed that the required weekly and monthly tests of the fire alarms and fire fighting equipment are carried out and are up to date. Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 3 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X x X 3 3 X Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 25 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 YA3 Regulation 14 Requirement The registered provider must ensure that a re assessment of two residents needs, is carried out. The necessary action must be taken to so that the residents concerned are living in a Home able to meet all of their needs. Timescale for action 10/02/08 2 YA7 14 3 YA20 13.2 Two residents risk assessment 10/01/08 records need to be updated and relevant to the resident’s current Home. The medication fridge must be 17/12/07 made secure, with a suitable lock fitted on it on. 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 YA2 Good Practice Recommendations The admission criteria should be up to date and set out whom the Home can admit . Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Channel View DS0000008133.V350279.R01.S.doc Version 5.2 Page 27 - 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!