Inspection on 27/06/06 for Cherry Tree Lodge

This inspection was carried out on 27th June 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 but made no statutory requirements on the home.

Other inspections for this house

Cherry Tree Lodge 24/03/09

Cherry Tree Lodge 18/07/07

Cherry Tree Lodge 16/02/07

Cherry Tree Lodge 23/01/06

Cherry Tree Lodge 26/09/05

Cherry Tree Lodge 21/03/05

Cherry Tree Lodge 18/11/04

Cherry Tree Lodge 01/03/04

Cherry Tree Lodge 04/12/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Cherry Tree Lodge 100 Wick Lane Southbourne Bournemouth Dorset BH6 4LB Lead Inspector Catherine Churches Unannounced Inspection 10:00 27th June 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000003929.V301703.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000003929.V301703.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Tree Lodge Address 100 Wick Lane Southbourne Bournemouth Dorset BH6 4LB 01202 429326 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) Mrs Audrey Martha Watts Mr John William Watts, Mr Simon John Watts Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places DS0000003929.V301703.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2006 Brief Description of the Service: Cherry Tree Lodge is registered as a care home, providing accommodation for up to twenty older persons. The home is situated in a quiet residential area of Wick, approximately 10 minutes walk from the shops and facilities of Tuckton. The home is registered in the name of Mr and Mrs Watts and their son, Mr S Watts. Mr S Watts is in day-to-day charge of the home. Accommodation at Cherry Tree Lodge is arranged over two floors. On the ground floor there are nine single bedrooms all with en-suite WC and wash hand basins. There is also a communal bathroom with WC and two further communal lavatories. On the first floor there is one double and nine single bedrooms all with en-suite WC and wash hand basin and two also have baths in the en-suite facilities. All bedrooms have been personalised by their occupants and reflect individual taste. The communal space on the ground floor comprises a lounge with adjoining dining room. Both rooms are attractively furnished and have a welcoming, relaxed atmosphere. A stair lift is available to assist residents between floors, leaving just one step to negotiate to access the first floor. The home has level, well-maintained gardens surrounding it and limited off road parking. There is also ample parking on the roads surrounding the home. The home has a number of pets including a cat, dogs and a parrot. DS0000003929.V301703.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key, unannounced inspection undertaken 27 June 2006. The inspection took place as part of the regular, programmed inspection schedule for the home. The last inspection was January 2006. The purpose of this visit was to monitor the homes compliance with National Minimum Standards and compliance with requirements and recommendations made during the previous inspection. Also, to check that the home is run in a satisfactory manner and that the people who are living in the home are properly cared for. The premises were inspected and a number of records examined. Time was also spent time observing routines within the home and talking with residents, visitors and staff. Prior to the inspection survey/comment cards were sent out to residents, relatives, GP’s, healthcare professionals and care managers. A total of 16 cards were returned, 8 from residents and 8 from relatives. Responses were generally favourable with a number of positive comments, a selection of which are detailed below together with some of the comments received during the inspection: “Everyone on the staff is very kind, helpful and friendly” “My Mother is content and well looked after” “ I am very satisfied with the care my Mother receives” “My Mum is happy with the accommodation, care and food at Cherry Tree” What the service does well: Cherry Tree Lodge provides a homely, relaxed and comfortable environment with a welcoming and friendly atmosphere. The home is well presented and has attractive gardens. Residents are supported in maintaining contact with family and friends and appropriate assistance is given to enable them to retain their rights to exercise choice and control over their lives wherever possible. Visitors are encouraged to come to the home whenever possible. The staff group is stable and were observed to be respectful, helpful and caring. The staffing level is good and provides opportunities for staff to take residents on one to one trips and spend time chatting in the lounge etc. DS0000003929.V301703.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000003929.V301703.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000003929.V301703.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is judged as adequate. This judgement has been made using available evidence including a visit to this service. Assessments of prospective residents needs have improved since the last inspection. This means that residents can now be more certain that the home is aware of their requirements prior to their admission to the home and that the staff will therefore be able and prepared to meet these needs. EVIDENCE: Documentation for three residents was examined as part of the case tracking procedure used during this inspection. Two of these residents had been newly admitted to the home since requirements were made at the last inspection regarding pre-admission assessments. Both assessments were viewed. They contained good information about each persons needs although it was noted that there was little or no information regarding current medication, social interests or personal safety. There was no written confirmation to the prospective resident that, following assessment, the home could meet the person’s needs. DS0000003929.V301703.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is judged as adequate. This judgement has been made using available evidence including a visit to this service. Care planning and documentation of care needs for residents has improved since the last inspection. This means that the home is now better able to demonstrate that it understands, and is aware of each person’s needs and can show how these are met. However, there are still a few weaknesses and further work in this area is required. The home ensures that resident’s healthcare needs are met through seeking appropriate input from GP’s and other healthcare professionals. In the main medication in the home is well managed. Systems are weak for the management of new residents’ medication and this may place residents at risk of harm. The ethos in the home is one of respect for the residents living there. This means that the residents feel settled at the home and their privacy is respected. DS0000003929.V301703.R01.S.doc Version 5.2 Page 10 EVIDENCE: Documentation for three residents was examined as part of the case tracking procedure used during this inspection. All three residents were also spoken with either in the privacy of their rooms or in the communal lounge. The detail and content of care plans has generally improved. Records document each person’s daily needs and how assistance is provided. Weights were checked monthly and daily records were up to date. It was noted that where an individual has a more specialised need or problem, care plans were lacking in detail about who the matter had been discussed with how the matter was to be managed. Monthly reviews were being undertaken but had not been dated or signed. Policies regarding pressure area care were lacking in detail and would not provide support to staff should they need to refer to this. Medicines in the medication cupboard were examined together with administration records. These were found to be satisfactory. Those staff responsible for medication administration have received appropriate training. It was noted that the administration of medication to a newly admitted resident was not being recorded and that prescribed items requiring refrigeration were not stored in a locked container. Policies for the promotion of privacy and dignity were reviewed and found to be satisfactory. Observation of interaction between residents and staff evidenced that residents are respected and a number of staff actions evidenced that privacy is actively promoted. Residents also confirmed during discussions that they felt their privacy was respected and their dignity promoted. Staff confirmed that they promote and maintain resident’s privacy when receiving personal visits from professionals such as GP’s and solicitors, family and friends. It was observed that staff knock on doors before entering and that residents preferred form of address is recorded and used. DS0000003929.V301703.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. Cherry Tree Lodge provides a caring, homely and relaxed environment. Open visiting arrangements are in place enabling residents to retain contact with families and friends. Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and needs. EVIDENCE: Cherry Tree Lodge provides occasional organised activities such as concerts from visiting musicians and various games such as bingo and “Play your cards right”. In addition the home has a wide selection of CD’s and videos and staff confirmed that they have the time to spend with residents, either singing, playing games or chatting in the lounge or perhaps taking people out for occasional walks. DS0000003929.V301703.R01.S.doc Version 5.2 Page 12 Residents are encouraged to maintain contact with family and friends and there was a steady stream of people coming and going from the home during the inspection. Two visitors were spoken with and were very positive about the welcome they receive and the care provided for their loved ones at Cherry Tree Lodge. Food records and discussions with residents confirmed that a suitable and varied diet is provided in the home. Food stocks were satisfactory and plenty of fresh provisions were available. DS0000003929.V301703.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is judged as poor. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory system for making complaints. This means that residents and others involved in the home that may wish to make a complaint should feel confident that they would be taken seriously and that matters of concern will be acted upon. Adult protection policies are weak and staff had not received training in Adult Protection. The home is therefore putting residents at potential risk as a lack of knowledge may mean that an abuse is not noted. EVIDENCE: Cherry Tree Lodge has a satisfactory complaints procedure that is included in the Service Users Guide and residents contract. Those spoken to, as well as those that responded to questionnaires, confirmed that they knew how to make complaints and would feel able to do so should the need arise. No complaints have been made either to the home or to CSCI since the before that last inspection. Policies and procedures were available regarding the protection of vulnerable adults from abuse. Information regarding the types of abuse and identifying these was lacking well as information about the action that should be taken if abuse is suspected. Staff have still not been trained in recognising the DS0000003929.V301703.R01.S.doc Version 5.2 Page 14 symptoms of abuse and the actions they should take should they suspect this has occurred. Both the Whistle blowing and Adult Protection policies referred to a previous registering authority and should be amended to include reference to CSCI. DS0000003929.V301703.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. The home is nicely presented. Residents live in a well-maintained environment, which was clean, hygienic and free from offensive odours. EVIDENCE: A tour of the premises confirmed that the home is nicely decorated and furnished. Dorset Fire and Rescue Service have visited the home and confirmed that it complies with their requirements. Cherry Tree Lodge is very well maintained with good access to communal areas. It is light and airy and furnished and decorated to a good standard. The atmosphere is homely and relaxed. Since the last inspection the dining room, lounge and front hall have been redecorated with plans to redecorate the rest of the corridors and other areas of the home during the coming year. DS0000003929.V301703.R01.S.doc Version 5.2 Page 16 All of the areas seen during this inspection were clean and no offensive odours were detected. Infection control policy and procedures were reviewed and found to be satisfactory. DS0000003929.V301703.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is judged as poor. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met through the provision of a mix of experienced, qualified and unqualified staff. Limited progress has been made in ensuring that staff have achieved recognised National Vocational Qualification (NVQ) training courses. This means that staff may not have the basic competencies in some areas required of them. Vetting practices for the appointment of new staff are out of date. The home has therefore potentially put residents at risk by employing staff without undertaking suitable checks. The arrangements for the induction training of staff do not comply with minimum requirements, as it is not undertaken within the required timescales. This means that new staff may be delayed in acquiring the necessary skills and therefore not be able to provide the required care in a safe manner. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number staff to meet the needs of residents. Staff and residents spoken with confirmed that they were satisfied with staffing levels. DS0000003929.V301703.R01.S.doc Version 5.2 Page 18 Only two of the fourteen care staff has achieved the minimum NVQ level 2 qualification in care. Staff records were examined for three newly appointed members of staff. Records demonstrated serious omissions as all staff had commenced their duties without updated POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) checks. Induction records for new staff demonstrated that induction training was being given but not within the required timescale of six weeks from the start of employment. DS0000003929.V301703.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is judged as adequate. This judgement has been made using available evidence including a visit to this service. Mr Watts acts as the homes’ manager although not yet registered as such. Lines of communication and leadership have continued to improve since July 2005 therefore improving continuity for residents. Quality monitoring systems still need to be better defined and coordinated in order to demonstrate that the home is run in the best interests of the residents. Satisfactory practices and procedures are in place regarding residents’ finances however this is not supported by documentary evidence. The health, safety and welfare of residents and staff is protected by the systems that the home has in place for staff training, maintenance and risk assessment. DS0000003929.V301703.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mr Watts has now taken over the major management role and is reviewing the staff structure as it has been recognised that in a home of this size he needs a deputy manager and senior carers to help share the management of the home and ensure that all tasks are dealt with efficiently. Mr Watts has considerable experience of managing a care home but does not yet have the required qualification. A quality assurance system has developed by the home but as yet no proactive action has been taken in the home to identify its strengths and weaknesses, by means of surveys etc. A suggestion box has been placed in the main entrance. The assistant manager confirmed that residents are encouraged to retain control of their own finances for as long as possible. Where they state that they no longer wish to or they lack the capacity to do so then the home ensures that either family or other representatives such as solicitors take on this role. She also confirmed that the home does not hold cash or valuables for any resident. There were no written policies available in the home regarding resident’s finances. Fire records, staff training records and accident books were examined and found to be up to date and detailed. DS0000003929.V301703.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 DS0000003929.V301703.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement The registered person must ensure that service users are protected from abuse. Written policies and procedures must be in place for responding to suspicion or evidence of abuse or neglect (including whistle blowing) ensure the safety and protection of service users, including the passing of concerns to CSCI in accordance with the Public Interest Disclosure Act 1998 and Department of Health Guidance, No Secrets. The registered person must make arrangements by training of staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse 27/6/06 This is the second time this requirement has been made. Failure to comply may result in enforcement action being taken. The registered person must operate a thorough recruitment procedure based on equal opportunities and ensuring the DS0000003929.V301703.R01.S.doc Timescale for action 1. OP18 12(1) 30/08/06 2. OP18 13 30/09/06 3. OP29 19 30/08/06 Version 5.2 Page 23 4. OP36 18 &19 protection of service users. A Criminal Records Bureau and POVA check must be obtained prior to an employee commencing duties or being confirmed in post. 27/6/06 This is the second time this requirement has been made. Failure to comply may result in enforcement action being taken. Care staff must receive formal supervision that covers all aspects of practice, philosophy of care in the home and career development needs, at least six times a year. 27/6/06 Not assessed on this occasion. This requirement is therefore carried over for the next inspection. 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The registered person should ensure that all pre-admission assessments include information regarding a person’s current medication, social interests and personal safety. The registered person must confirm in writing to the resident that having regard to the assessment the care home is suitable for the purpose of meeting the residents needs in respect of his/her health and welfare. The registered person should ensure that care plans for residents with very individual/specialised needs are very clear in detail regarding the specific needs and how these are met. E.g. medical conditions or behavioural patterns/problems. The registered person should ensure that monthly care plan reviews are signed and dated. 1 OP4 2 OP7 3 OP8 DS0000003929.V301703.R01.S.doc Version 5.2 Page 24 4 OP8 5 OP9 6 7 OP9 OP18 8 OP28 9 OP30 10 OP31 11 OP33 12 OP35 Policies and procedures for the promotion of tissue viability and prevention or treatment of pressure sores must be developed and implemented. Records must be kept of the administration of all medication to residents including any new admissions to the home whose records are not yet included in the pharmacy computerised MAR (Medication Administration Record) chart. Any medications that require refrigeration should be stored in a lockable container within the fridge. Policies for Whistle Blowing and the Protection of Vulnerable Adults should be updated to include contact details of CSCI. A programme should be submitted detailing how the required minimum of 50 staff trained at NVQ2 will be met and the timescale in which this will be achieved. 27/6/06 this is the second time that this has been required. All staff must receive induction and foundation training to NTO specification within 6 weeks of appointment to their posts. It is recommended that the proposed registered manager complete NVQ level 4 in management to promote management competency and ensure that good practice is implemented. Further work must be undertaken with regard to quality assurance systems in the home in order to demonstrate that the home is meeting its aims and objectives and Statement of Purpose. Policies and procedures must be developed and implemented that clearly state how the home will, or will not, be involved with residents finances and how items additional to the monthly fees will be paid for etc. DS0000003929.V301703.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000003929.V301703.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. 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!