Inspection on 22/05/06 for Chant Square (15 &17)

This inspection was carried out on 22nd May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chant Square (15 &17) 15/05/07

Chant Square (15 &17) 19/12/05

Chant Square (15 &17) 21/04/05

Chant Square (15 &17) 09/12/04

Chant Square (15 &17) 04/05/04

Chant Square (15 &17) 29/09/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Chant Square (15&17) 15 & 17 Chant Square Stratford London E15 Lead Inspector Sarah Greaves Key Unannounced Inspection 22 and 23rd May 2006 11:00 nd Chant Square (15&17) DS0000022832.V295192.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 Chant Square (15&17) DS0000022832.V295192.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. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chant Square (15&17) Address 15 & 17 Chant Square Stratford London E15 020 8519 0551 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) East Living Limited Mrs Harpavan Sonia Sandhu Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: 15-17 Chant Square is a registered care home for people with a learning disability. The home comprises of a seven- bedded unit (no.15) and a one bedded flat (no.1). The home is situated in Stratford, close to local shops, amenities and public transport facilities. The home occupies two ordinary domestic properties in a residential street. East Living manages 15-17 Chant Square, which is a local care provider and housing association. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector conducted an unannounced inspection on the 23rd May 2006. The inspector gathered information through speaking to service users, staff and the registered manager. Some of the service users were not able to verbally communicate due to their disability; therefore the inspector observed their interactions with staff. The inspector checked the home’ s management of the service users medications and read two care plans. Staff training records, policies and procedures, and health and safety records were also checked. The inspector observed a staff meeting on the 23rd May and made an announced return to the service on the 24th May to continue the inspection. What the service does well: What has improved since the last inspection? Seven requirements and three recommendations were issued in the last inspection report. The home had improved upon its practices to promote service users choices and provided more detailed information in the risk assessments. The renewal of a couple of health and safety checks by external persons had been addressed and there was a continued positive development in supporting service users to access community facilities. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 6 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. Chant Square (15&17) DS0000022832.V295192.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 Chant Square (15&17) DS0000022832.V295192.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective service users are provided with comprehensive information about the home and provided with opportunities to visit. Their needs are carefully assessed prior to admission. EVIDENCE: A requirement was issued in the previous inspection report for the home to remove a reference to the former local authority registration and inspection unit; this was noted to have been undertaken. A recommendation was also issued for the home to ensure that the Statement of Purpose provided comprehensive details regarding how service users were supported to meet any identified spiritual needs, and how service users were assisted to maintain external friendships and relationships. This information had now been enclosed. The inspector also read the Service Users Guide, which was found to be comprehensively presented. Via discussion with the registered manager, the inspector established that there had not been any new admissions to the home for over a year. The inspector had previously monitored the admission process for the most recently placed service user and noted that the home had offered a very detailed and individualised approach to gathering relevant pre-admission information and enabling the service user to visit the home on several occasions for meals, over night stays and a full weekend. The staff had also met with relevant parties (family members, day centre staff, and health and social care professionals) in order to discuss the pre-admission assessments. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 9 Chant Square (15&17) DS0000022832.V295192.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The care plans and risk assessments demonstrated a good understanding of the social and health care needs and aspirations of individuals. Service users were supported to make choices; however, advocacy for non-verbal service users was limited due to a lack of external resources. EVIDENCE: The inspector read two care plans during this inspection. The home had undertaken a considerable amount of work to improve upon the standard of the care plans in the early part of last year. The care plans were noted to be well constructed at the last inspection and this good standard had been maintained. The care plans were presented in a recognised model of ‘Person Centred Planning’ with accompanying information to assess and plan for the social and health care needs of individuals. The inspector noted that some of the placing authorities undertook annual reviews; Newham Social Services had advised that a review would be convened if there were changes in the service users circumstances. Some of the service users attended fortnightly meetings facilitated by the ‘People First’ advocacy organisation. The registered manager demonstrated a Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 11 keenness to promote more self-advocacy opportunities for the service users; however, there were waiting lists for admission to these groups. One of the service users attended a self-advocacy discussion group for women with learning disabilities and another service user had applied to join this group. The advocacy opportunities for service users who were not able to verbally communicate were raised at the last inspection. The registered manager stated that she was still trying to find an external independent advocate to facilitate service users meetings and was planning to visit an East Living home in Essex to observe how staff facilitated inclusive service users meetings. The inspector observed that service users were offered choices through verbal consultation (if feasible) and through the use of items and pictures of reference. Pictorial charts had been developed to enable service users to choose their favourite foods for the weekly shopping and menu plan. A requirement was issued in the previous inspection report for the home to improve upon the standard of the risk assessments. The inspector looked at two care plans and observed that these documents were written in a detailed and clear style. Chant Square (15&17) DS0000022832.V295192.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are offered fulfilling activities and opportunities to maintain friendships and relationships. The rights of service users are promoted, and a good and varied diet is provided. EVIDENCE: The inspector discussed the social activities of all of the service users with the registered manager and specifically checked upon the activities recorded in two care plans. Service users attended dance and movement sessions, trampolining, hydrotherapy, aromatherapy massage and arts and crafts. The registered manager confirmed that holiday arrangements had been made for the service users, which included vacations to Euro Disney and Wales. Service users regularly accessed local amenities, such as restaurants, shopping centres, the theatre and places of worship. The frequent presence of the service users and their staff escorts within the community in Stratford has been observed by the inspector and was confirmed by service users with verbal communication. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 13 Service users were supported to maintain external friendships and relationships. Two service users were assisted to visit a relative in a local care home and the care plans documented important relationships. Service users were observed to choose their own routine within the home, for example, if they wished to sit in the television lounge, the quiet lounge or in their own room. Staff were observed to knock on service users bedroom doors and respect the service user’s entitlement to privacy. The menu plan evidenced that a healthy range of foods were provided. The minutes for staff meetings demonstrated that a district nurse had recently provided a teaching session about diabetes; the inspector noted that suitable food items were available for service users that needed a special diet. The menu plan offered meals that met cultural and individual preferences. Chant Square (15&17) DS0000022832.V295192.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The health and emotional needs of service users were appropriately addressed; however, the home must ensure a more vigilant approach for the recording on medication administration records. EVIDENCE: The care plans read by the inspector verified that the personal care needs of service users were identified and appropriately planned for. The inspector observed that service users were provide with manicures by staff and the home possessed pampering equipment such as a foot spa. Via discussion with the registered manager, no issues of concern were identified with service user’s access to health care services. The registered manager identified that the home were prompt in seeking referrals for supporting service users with speech and language, weight management and mobility needs. The home had commenced putting together Health Action Plans for the service users. The inspector looked at the work achieved so far and will be monitoring the home’s progress with this task at the next inspection visit. The inspector checked the home’s management of the service users medication needs. The inspector found that staff had not consistently used a Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 15 black pen for recording that medication had been administered and a 2.5mg tablet in the blister pack had been recorded as a 25mg dosage on the medication charts. The home had already implemented a system of assigning two members of staff to write and check over the medication charts. The inspector observed that prescribed topical lotions were not consistently kept in a secure place within service user’s bedrooms; this was rectified during the inspection. At the time of this inspection, the service provider was revising the medication policy and the home were following guidance from ‘The Administration And Control of Medications In Care Homes And Children’s Homes’ issued by the Royal College of Pharmacists. The inspector will check the home’s medication policy at the next inspection. Chant Square (15&17) DS0000022832.V295192.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users were protected through a comprehensive complaints procedure and staff training in Adult Protection. The Adult Protection procedure was satisfactory; however, the whistle-blowing policy needs to be amended. EVIDENCE: The complaints procedure was clearly written and a pictorial version was also provided. No issues of concern were identified with the home’s management of complaints. There had been one complaint since the last inspection, which the inspector discussed with the registered manager and staff during the team meeting. This complaint was being investigated at the time of this inspection. The home possessed an appropriately written Adult Protection procedure and permanent staff had received training related to the protection of vulnerable adults. The inspector spoke to a care worker employed by the service provider’s bank of relief staff who had not received Adult Protection training. A requirement was issued in the previous inspection report for the home to ensure that the whistle-blowing policy informed staff that they could whistleblow (anonymously if required) to the Commission for Social Care Inspection. The whistle-blowing policy viewed at this inspection did not contain this, although the home had previously displayed information for staff advising that they could contact the Commission. The Commission for Social Care Inspection was previously informed that a member of staff was being investigated for leaving the premises without authorisation. The registered manager stated that the employee had resigned and the Protection of Vulnerable Adults register had been informed. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 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 the following standard(s): 24, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are provided with a comfortable and clean home that meets their mobility needs. EVIDENCE: The premises were pleasantly decorated, comfortable and homely. The home offered two lounges, shared between seven service users. The inspector toured the separate flat, which is the home of one service user. The flat was being decorated at the time of the last inspection; this work was completed and the service user had purchased new furniture. The inspector looked at the home’s aids and adaptations, which included hoists, adapted baths and adjustable beds. As reported upon in Standard 19, the registered manager was pro-active in seeking referrals to professionals such as physiotherapists and occupational therapists in order to ensure that service users receive appropriate equipment for their assessed needs. The home was observed to be clean and free from any offensive odours. The carpets were professionally cleaned on the second day of this inspection. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home evidenced some strengths in the provision of staff training, particularly through its links with external professionals. However, the service must ensure that all staff possess mandatory training and that bank staff receive a full induction. Staff receive good supervision. EVIDENCE: The registered manager stated that the home now had approximately five vacancies for care staff. Shortfalls in staffing levels were being filled by bank and regular agency staff. The inspector was concerned to find out from a bank worker that they did not know that the home possessed a Statement of Purpose or Service Users Guide, or were aware of the contents of these documents. The bank and agency staff on duty at the time of the inspector’s arrival on the 22nd May also stated that they were not familiar with the service user’s care plans. The home had established a work force comprising over 50 of staff with a minimum of National Vocational Qualification level 2. The inspector looked at the training profiles for two members of staff; it was noted that one care worker was overdue their refresher manual handling training. On the first day of the inspection, staff attended a training session from a clinical psychologist and they received a talk from an East Living manager during the team meeting about a behavioural analysis model for supporting service users. Staff had Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 19 received training in ‘person centred planning’, and ‘multi-media skills’ for devising pictorial information that could be shared with the service users. The inspector looked at the supervision records for two members of staff; supervision was regularly conducted and of a comprehensive manner. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home was generally well managed, although two outstanding requirements have been repeated in this report. Systems for enabling service users to participate in the home’s quality assurance must be developed and a more diligent approach to ensuring quality monitoring by the service provider must be applied. Attention to consistently ensuring the safety of service users cooked meals needs to be achieved. EVIDENCE: The registered manager evidenced that the home provided a good service to meet the social and health care needs of the service users. Five out of the seven requirements and both recommendations in the previous inspection report were satisfactorily met. The inspector observed a staff meeting conducted by the registered manager; useful information was shared and staff were encouraged to contribute their views. The home demonstrated that views about the service were sought from service users and their representatives during statutory and internally conducted Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 21 reviews and the service provider had previously arranged quality assurance forums for service users. The home did not evidence any quality assurance initiatives that involved the service users (and their representatives) in the past year. The inspector looked at the monthly-unannounced monitoring visits reports undertaken by the area manager. It was noted that visits to the home did not occur in March and April 2006. The inspector acknowledged that the home did not have an area manager in post at this time; however, the service provider must ensure that the needs of the service users are met via these qualitymonitoring visits, in accordance to the Care Homes Regulations. The inspector checked the following health and safety practices, which were found to be satisfactory; (1) portable electrical appliances testing (2) electrical installations inspection by a competent person (3) landlord’s gas safety certificate (4) professional maintenance of the fire equipment (5) the fire safety and evacuation plan and (6) refrigerator and freezer temperatures. A requirement was issued in the previous inspection report for the home to ensure the consistent recording of food temperatures at weekends and any other occasion that the cook was not present. The inspector noted some improvement in this area but this requirement was not satisfactorily attained. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X 2 2 X Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 23 YES 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 YA23 Regulation 13 (6) Requirement The registered manager must ensure that the whistle-blowing policy includes information to advise staff of their entitlement to contact the CSCI. This is a repeated requirement. The registered person and the registered manager must ensure that bank staff receive appropriate induction training. The registered manager must ensure that permanent and bank staff receive applicable mandatory training. The registered manager must ensure that service users are supported to contribute to the home’s quality assurance monitoring. The registered person must ensure that unannounced monitoring visits to the home are conducted monthly. The registered manager must ensure that the food temperatures are recorded daily. This is a repeated requirement. DS0000022832.V295192.R01.S.doc Timescale for action 31/07/06 2. YA32 18 (1) (c) 30/09/06 3. YA35 18 (1) (c) 31/08/06 4. YA39 24 31/10/06 5. YA41 26 30/06/06 6. YA42 13(3) 30/06/06 Chant Square (15&17) Version 5.2 Page 24 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 YA20 Good Practice Recommendations The home needs to ensure that: (1) The registered manager audits medication charts once a week. (2) Staff use a black pen for writing on the medication charts. (3) Prescribed creams and lotions are kept securely in service users bedrooms. Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Chant Square (15&17) DS0000022832.V295192.R01.S.doc Version 5.2 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. 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