Inspection on 17/08/06 for Cobham Road (60)

This inspection was carried out on 17th August 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cobham Road (60) 07/11/05

Cobham Road (60) 14/07/05

Cobham Road (60) 17/11/04

Cobham Road (60) 06/07/04

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Thorndene

Insight - Eastchurch

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33 St John`s Church Road

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

CARE HOME ADULTS 18-65 Cobham Road (60) 60 Cobham Road Fetcham Surrey KT22 9SS Lead Inspector Deavanand Ramdas Unannounced Inspection 17th August 2006 10:00 Cobham Road (60) DS0000013894.V308327.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 Cobham Road (60) DS0000013894.V308327.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. Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cobham Road (60) Address 60 Cobham Road Fetcham Surrey KT22 9SS 01372 379623 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) londonroad@tiscali.co.uk Milbury Care Services Limited Mrs Rosalind Herty Mensah Dodd Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 30-60 YEARS OF AGE 7th November 2005 Date of last inspection Brief Description of the Service: Cobham Road is registered with the CSCI (commission for social care inspection) to provide accommodation and care for six service users with a learning disability. The property is located in a residential area and in close proximity to Epsom, Guildford and Leatherhead town centres. Accommodation is on two floors accessed by stairs and comprises of an office, lounge, kitchen, dining room, laundry room, bathrooms, toilets and six single bedrooms. The home has a garden to the rear of the property which is secure and private parking is available. The fee charged by the home is £1057 per week. The registered provider is Milbury Care Services Limited and the registered manager is Rosalind Dodd. Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes key inspection by the CSCI (commission for social care inspection) and carried out by one inspector over a period of six hours. A tour of the premises took place, staff and service users were spoken to, and documents and records were examined. The inspector noted service users living at the home have communication difficulties and judgements were made about them based on their mood, behaviour and information given by staff. The inspector would like to thank the manager, staff, service users and relatives for their contribution to the inspection. What the service does well: What has improved since the last inspection? The home has made improvements to the laundry and bathrooms by replacing the flooring to prevent the spread of infection in the home. Medication training for staff has improved and staff have accredited training in medications to promote the health of service users. Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 6 The storage of COSHH (control of substances hazardous to health) products have improved and observations confirmed such products are stored in a locked cupboard to promote the health and safety of staff and service users. 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. Cobham Road (60) DS0000013894.V308327.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 Cobham Road (60) DS0000013894.V308327.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes statement of purpose and service user guide is good ensuring service users have up to date information on which to make decisions about admission to the home. The arrangements for assessing needs are good ensuring prospective service users’ aspirations and needs are assessed before admission to the home. EVIDENCE: The home has a statement of purpose and service user guide which is written in plain English, nicely presented and available in the home for information. The manager is aware of the disability of service users and information was in a widget format (a method of communication using pictures and symbols) to make the information accessible to service users. The manager stated prospective service users would be admitted to the home after a full assessment of needs and commented service users have individual care plans based on the home’s needs assessment. The inspector sampled records and noted needs assessment covered the areas of personal support, health care needs and social activities. A relative commented ‘‘I am very pleased with the way my brother is cared for’’. A review of procedures indicated the home had an Everyday Living Skills assessment and an Adaptive Behaviour Scale used to assess prospective service users. The inspector noted the home offered service users a ‘settling in’ period of three months to ensure existing service users are compatible with a prospective new service user to the home. Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 9 Cobham Road (60) DS0000013894.V308327.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&9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems for care planning are good ensuring the needs of service users are reflected in their individual care plans. Decision making in the home is good ensuring service users make decisions about their lives with assistance as needed. The arrangements for risk taking are good ensuring service users are supported to take risks as part of an independent lifestyle. EVIDENCE: The manager stated the home had individual care plans to record the changing needs and personal goals of service users. The inspector sampled individual care plans which were nicely presented and noted service users had named key workers to promote consistency of care and support. Care plans were regularly reviewed, agreed changes recorded and appropriate action taken. A relative commented ‘‘I am very pleased with the treatment my son is getting at Cobham Road’’ and a member of staff remarked ‘‘service users are going to live a long time, they have the best food and exercise twice a week’’. The manager commented staff respected service users’ right to make decisions and the home had introduced service users’ meetings to promote decision making Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 11 in the home. The inspector sampled minutes of service users’ meetings and noted the last meeting was held on 27/07/06 and discussions covered areas of activities, holidays and care needs. It is recorded two service users went on holiday to France and relatives were involved in the decision-making process. The manager stated the home had a policy on risk taking and a review of records indicated staff have training in risk assessment. The inspector sampled risk assessment documentation and noted it reflected actions to minimise risks and promote the independence of service users. Risks assessments were regularly reviewed, dated and signed by management and key workers to ensure good information on which to base decisions. Cobham Road (60) DS0000013894.V308327.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&17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for occupation are good ensuring service users participate in fulfilling activities. Community links and social inclusion are good ensuring service users are part of the local community. The arrangements for relationships are good ensuring service users maintain family links and friendships. The daily routine of the home is good and promote the independence and freedom of movement of service users. Meals at the home are good and offer variety and choice. EVIDENCE: The manager stated service users participated in fulfilling activities and a review of the homes activity programme and daily log indicated service users attended a day centre for structured activities including arts and crafts, drama therapy, aromatherapy and physical exercise to promote health. During discussions a member of staff stated ‘‘service users do a lot of helping around the home and shopping’’. The manager commented staff supported service users to participate in the local community and a review of the homes’ records indicated service users made use of the local shops, pubs, cinema and other Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 13 facilities. On the day of the inspection, staff supported service users in the community and observations confirmed service users were happy and smiling which indicated satisfaction with activities. The inspector noted staff working at the home are of African ethnicity and are aware of the race and ethnicity of all service users living in the home. One service user who is Afro-carribean has a key worker who understands his cultural heritage and special dietary needs. Another service user who is Roman Catholic is supported to attend church to mark special religious occasions and events. The manager remarked staff supported service users to maintain family links and a review of records indicated staff arranged for one service user to visit his elderly mother at home on the 26/06/06 which is recorded in the homes diary. The manager stated the daily routine of the home promotes independence and observations confirmed service users moved freely in the home. The inspector noted staff addressed service users by their preferred names and the manager knocking on doors before entering service users bedrooms to promote the privacy of service users. The home had a menu plan displayed in the dining room for information and service users participated in planning the menu. On the day of the inspection service users had fish, chips and peas for lunch and dessert was fruit salad. Drinks including coke, fruit juice and water was available in the dining room. Meals were nicely presented and service users were supported through staff supervision and verbal prompts to promote safety. Observations confirmed service users enjoyed their meals and were happy and smiling during lunch. Following discussions with the manager a recommendation has been made for the menu plan to be revised to indicate arrangements for supper to promote the nutrition of service users. Cobham Road (60) DS0000013894.V308327.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&20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for personal support are good ensuring service users receive personal support in the way they prefer and require. Access to healthcare is good ensuring service users physical and emotional needs are met. The management of medications need strengthening to promote health. EVIDENCE: The manager stated staff provided flexible support to service users based on personal choice and personal care is provided in private to promote the dignity of service users. Observations confirmed service users had good personal hygiene, were appropriately dressed and guidance regarding personal hygiene were recorded in individual care plans. The manager remarked service users are registered with a GP and have access to a dentist, chiropodist and optician. The inspector sampled records and noted a psychiatrist visited the home to review the medications of service users and a dental nurse carried out an assessment of service users to promote health. The home had a policy on medications and staff have accredited training in medications to promote good practice. The inspector sampled records and noted medication record sheets had a recent photograph of the service user and were dated and signed by Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 15 staff. The manager commented the home had a service level agreement with a local chemist and observations confirmed the home had an audit carried out by a pharmacist on 20/02/06 and no recommendations were made. Following discussions with the manager a requirement has been made for the record of medications returned to the pharmacy to be signed by a pharmacy staff to prevent mishandling of medications and the practice of staff copying prescriptions onto medication record sheets to be reviewed to promote the health of service users. Cobham Road (60) DS0000013894.V308327.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&23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaint process at the home is good ensuring complaint information is available to staff, service users and relatives. The arrangements for protection are good ensuring service users are protected from harm and abuse. EVIDENCE: The manager stated the home had a complaints policy and staff have training in complaints. The inspector noted staff have an understanding of the disability of service users and the complaints policy was in a pictorial format to reflect the communication needs of service users. The home kept a record of complaints made about the home with appropriate management action taken. No complaints were recorded about the home since the last inspection. The service user guide has information about complaints and during discussions a staff stated he was ‘‘aware of the complaints policy and procedures’’. The home has a policy on the protection of vulnerable adults and a whistle blowing policy to protect service users from abuse. The inspector sampled records and noted staff have training in safeguarding adults and the manager has completed a ‘train the trainers’ course in safeguarding adults to promote staff training and development in this area. There is no record of any safeguarding adult issues since the last inspection and during discussions a member of staff stated ‘‘any allegations of abuse would be recorded and actioned’’ to safeguard the welfare of service users. Cobham Road (60) DS0000013894.V308327.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&30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for the premises are good ensuring the home is safe and comfortable for service users. The systems for hygiene are good ensuring the home is clean and hygienic for service users. EVIDENCE: On the day of the inspection the home was clean, nicely presented and free from offensive odours. Observations confirmed the home had a good standard of décor and was bright and airy. Furniture and fittings were of good quality and the home had replaced the flooring to the bathroom and kitchen to make it nice for staff and service users. The inspector noted the home operated restricted access to the front entrance of the home to promote the safety of service users and the maintenance of the home was satisfactory and in keeping with the local community. The home had adequate laundry facilities and the flooring in the laundry room had been replaced to prevent the spread of infection in the home. Observations confirmed hand washing facilities were prominently sited in the kitchen, toilets and bathrooms and staff practiced infection control measures by washing their hands regularly. The manager stated the home had a policy on control of infection and staff had training in Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 18 infection control to ensure the environment is clean and hygienic for service users. Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 32,34&35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for qualifications are good ensuring service users are supported by competent and qualified staff. Recruitment and vetting practices are good protecting service users from harm and abuse. The systems for training and development are good ensuring service users needs are met by appropriately trained staff. EVIDENCE: The manager commented staff have the skills and experience necessary to support service users in the home. Observations confirmed staff were good listeners, communicators and were approachable and comfortable with service users. A review of staff training records indicated staff have completed LDAF (learning disability award framework) training and NVQ (national vocational qualification) training to give them the knowledge and skills necessary to work with service users in the home. The manager stated the home had a policy on staff recruitment and staff are vetted before being employed by the home. The inspector sampled staff recruitment files and noted employees have completed application forms, two references, statement of terms and conditions, job descriptions, a recent photograph and CRB (criminal record disclosure) information. Recruitment files were in good order and kept in a locked drawer to promote confidentiality of information. Following discussions with the manager a requirement has been made for staff to be given copies of Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 20 the codes of conduct and practice set by the GSCC (general social care council) to safeguard the welfare of service users. The manager remarked the home has an induction policy and staff have induction training. The inspector sampled staff induction training records and noted the home had a structured induction programme. Induction records were dated and signed by the employee, supervisor and training is linked to service users’ needs. During discussions a member of staff stated ‘‘I am happy with training opportunities’’. Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 37,3&42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The day to day management of the home is good ensuring service users benefit from a well run home. The systems for quality assurance are good ensuring service users and other stakeholders participate in the development of the home. The arrangements for safe working practices are good ensuring the health and safety of service users and staff are protected. EVIDENCE: The home has an experienced registered manager who provides management stability and leadership to the staff team. The manager has the RMA (registered manager award) qualification and is aware of the role and responsibilities involved in managing the home. The inspector noted there are clear lines of responsibility and accountability within the home and a management structure is in the statement of purpose for information. During discussions a member of staff stated ‘‘generally management is very good, they are approachable’’ Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 22 The manager stated the home had a policy on quality assurance and a review of records indicated the home conducted an annual service review on 13/06/06 involving staff, service users and other stakeholders to obtain feedback about the home. The inspector noted the home had regular Regulation 26 (monitoring visits) to promote quality assurance and the home has met the requirements made by the CSCI (commission for social care inspection) at the last inspection to improve the running of the home. During discussions a staff stated ‘‘the quality of care is very good’’. The manager commented the home had a policy on health and safety and a review of staff training records indicated staff have training in food hygiene, first aid, people handling, fire awareness and other appropriate and relevant training to promote the safety and welfare of service users. A review of reports indicated the home had a visit by an inspector from the local authority (surrey county council) on 24/05/06 and no action taken. Observations confirmed the kitchen was clean, food was appropriately stored and fridge and freezer temperatures were within normal limits. COSHH (control of substances hazardous to health) products were stored in a locked cupboard and the home had a current gas safety certificate, a legionella risk assessment and regular fire alarm tests to promote the safety of staff and service users. Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X 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 3 X X 3 X Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No. 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 YA20 Regulation 13(2) Requirement Timescale for action 01/09/06 3. YA20 13(2) 4. YA34 12(6) The registered person must ensure the practice of staff copying prescriptions onto medication record sheets is reviewed with the chemist to safeguard the welfare of service users and promote health. The registered person must 01/09/06 ensure the record of medications returned to pharmacy is signed by a pharmacy staff to prevent mishandling of medications. The registered person must 01/10/06 ensure staff working at the home have copies of the codes of conduct and practice set out by the GSCC (general social care council) to safeguard the welfare of service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 25 1. YA17 The registered person shall ensure the menu plans are revised to include the arrangements for supper to promote the nutrition of service users. Cobham Road (60) DS0000013894.V308327.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Cobham Road (60) DS0000013894.V308327.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!