Inspection on 05/03/07 for David Lewis Centre Adult Assessment Unit

This inspection was carried out on 5th March 2007.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

David Lewis Centre Adult... 06/03/06

David Lewis Centre Adult... 28/06/05

David Lewis Centre Adult... 03/02/05

David Lewis Centre Adult... 16/06/04

Similar services:

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Ashwood Court Unit 1

Clover House

Dystlegh Grange

Thornton Lodge

The Good Companions

Cuerden Grange Rest Home

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

CARE HOME ADULTS 18-65 David Lewis Centre Adult Assessment Unit Assessment Unit Mill Lane Warford Alderley Edge Cheshire SK9 7UD Lead Inspector Helena Dennett Unannounced Inspection 5th February 2007 09:30 David Lewis Centre Adult Assessment Unit DS0000018800.V321793.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 David Lewis Centre Adult Assessment Unit DS0000018800.V321793.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. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service David Lewis Centre Adult Assessment Unit Address 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) Assessment Unit Mill Lane Warford Alderley Edge Cheshire SK9 7UD 01565 640159 01565 640355 lynnsharrock@davidlewis.org.uk David Lewis Centre Care Home 9 Category(ies) of Learning disability (9), Mental disorder, registration, with number excluding learning disability or dementia (9), of places Physical disability (2) David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This service is registered for a maximum of 9 service users who suffer from seizure disorders to include: * Up to 9 service users in the category of MD (mental disorder excluding learning disability or dementia) * Up to 9 service users in the category of LD (learning disability) * Up to 1 service users in the category of PD (physical disability) * One named service user in the category PD (physical disability) under the age of 18 years The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The registered manager must obtain a nationally recognised qualification, at Level 4 NVQ or equivalent, in management before 1st April 2005 Service users accommodated for short stay periods must be 18 years and above Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 6th March 2006 2. 3. 4. 5. Date of last inspection Brief Description of the Service: The David Lewis centre is set in 170 acres of land and has a village atmosphere. The Centre’s drives are tree lined and there are extensive wellmaintained garden and playing fields. The grounds are pleasant and well cared for. There is a swimming pool, gymnasium, workshops and a social club. There is also a school and college on the site. The Adult Assessment Unit is a nine-bedded unit and its purpose is to provide an informal environment for detailed assessment of adults with complex epilepsy and other associated problems. The unit has nine single rooms, including one suitable for disabled persons, and two video telemetry rooms. The scale of charges range from £2,727.00 – £18,330 per treatment. This information was provided by the manager before the site visit. Additional information can be obtained from the manager of the unit. The inspection David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 5 report is available on the unit. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the David Lewis Centre, including this service, took place on 5, 6 and 7 February 2007. The visit was carried out by a group of 5 inspectors who looked at various aspects of this home and the way the David Lewis Centre runs. The visit was just one part of the inspection. Before the visit, the manager of the unit was asked to complete a questionnaire to provide CSCI with up to date information about the home. CSCI questionnaires were sent out for residents to fill in to find out what they think of the home. Other information received since the last key inspection was also reviewed. During the visit, various records were looked at; a tour of the David Lewis Centre, including this home, was carried out; and inspectors observed how patients and staff were working together. A number of patients and staff were spoken with. They gave their views and these have been included in this report. The people spoken with referred to themselves and others on the unit as ‘patients’. Therefore this term is used throughout the report. What the service does well: Patients admitted from the community are provided with good information on the unit and the facilities it provides. Wherever practicable, staff from the unit visit patients before admission. Patients are also invited to visit the unit so that they can feel more relaxed and at ease when they are first admitted. Detailed information is also obtained for patients from the community before admission so staff are aware of their needs. The Adult Assessment Unit is staffed by experienced, qualified staff so that they can meet the needs of people with epilepsy. Most of the staff have worked on the unit for some time and know the patients well. Staff were seen to work well with the patients and the atmosphere in the unit was cheerful and friendly. The standard of meals were good with alternative meals, such as a halal meal, being provided on request so that the diverse needs of patients could be met. There is a good quality assurance system in place so patients can be confident that they will receive a good service that meets their needs. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 8 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 David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although patients from outside the David Lewis Centre make a positive choice about coming into the assessment unit this is not always the case with service users being transferred from other units within the centre. EVIDENCE: Five people were resident on the Adult Assessment Unit during the site visit. One patient spoken with said that she had made a positive choice to come in to the unit to have her needs assessed. She said that admission to the Adult Assessment Unit was preferable to being admitted to hospital for assessment. The following comment was made on a comment card returned to CSCI before the site visit: ‘I was fully informed about the reason for my admission, I was asked for my permission for my admission to be arranged before anything was acted on’. However, one service user was admitted as a patient to the Adult Assessment Unit from a residential house on site. There was no evidence to suggest that the service user had made a positive choice about moving to the unit. It was difficult to establish why the service user had been admitted as they did not appear to meet the criteria for admission set out in the unit’s statement of purpose and service user guide. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the assessment of patients admitted from outside the David Lewis Centre was good, there were problems with the assessment of one patient admitted from a residential house on the site and so there is a risk that her needs may not be met on the Adult Assessment Unit. EVIDENCE: One patient spoken with was very positive about the assessment process and confirmed that restrictions placed on her whilst undergoing the assessment process had been discussed with her. Two sets of care records were looked at. One of the care records contained a lot of information on the patient’s needs and how these would be met by staff on the unit. However, the other care records did not contain enough information on the patient’s health care needs to ensure that these would be met on the Adult Assessment Unit. The assessment of needs was not fully completed and the care plans did not reflect all of the patient’s needs so there was a risk that these needs may not be met. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 11 It was difficult to establish whether one service user had been consulted enough about moving to the Adult Assessment Unit and whether their views were sought. Risk assessments were generally satisfactory; however staff need to ensure that a falls risk assessment is carried out for service users identified at risk. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough activities offered around the Centre and within the constraints of their treatment, patients can choose how they spend their time, which helps them to keep control over their lives. EVIDENCE: There is a range of activities at the David Lewis Centre that the patients can do depending on the assessment process and treatment they require. The adult assessment unit is a short term assessment unit and patients are encouraged to attend day care facilities provided on site, as part of their assessment. Video-telemetry is used as a diagnostic tool and does affect the daily life of the person who is undergoing this type of assessment. This is agreed and consent is given before the treatment starts. Information submitted before the inspection indicates that this is an area that the unit wishes to explore further, as the day care services do not fulfil all of the needs of the service users on the Adult Assessment Unit. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 13 Some patients have helped out in the centre shop. However due to the need for assessment and treatment, some patients’ movements are more restricted. There is a large comfortable lounge on the unit for patients to use as well outdoor facilities. Visitors are welcomed at any reasonable time of the day. Patients were positive about the meals that were provided on the unit. They said they were given a choice and that the quality of the food was good. There was evidence that alternative meals can be provided on request, for example during December 2006 a patient required a halal meal which was provided. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the healthcare needs of patients were generally met by staff there were some problems identifying one patient’s health care needs and so there is a risk that these may not be met. EVIDENCE: Patients spoken with said that staff were ‘excellent’. They felt their physical and emotional needs were met. The following comment was made on a comment card returned to CSCI before the site visit: ‘ although admission to this unit is a medical one, it is extremely homely, bright, clean and well furnished. It has a relaxed atmosphere and I have found all staff to be very caring and sensitive to the varying needs of the individual’ There was evidence in the care plan that staff were meeting the physical and emotional needs of most of the patients. However as stated previously, staff had not done a thorough assessment of one person’s needs and so there was a risk that this service user’s needs may not be met whilst resident on the Adult Assessment Unit. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 15 None of the patients on the unit looked after their own medicines. However it was noted that one patient had done so when living in another house run by the David Lewis Centre. An entry in the records indicated that it was not the policy for patients to self medicate on the Adult Assessment Unit. Information received prior to the site visit stated ‘AAU staff assume responsibility for the administration of medication, due to the nature of our work drug changes are done very rapidly.’ David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is enough information available to ensure that patients knew how to complain if they needed to. EVIDENCE: Information on the complaints procedure was available on the unit so patients knew who to contact if they had any complaints or concerns. Members of staff spoken with also knew the procedure to follow if a complaint was made. A policy on adult protection was in place. This has been reviewed since the last inspection and staff were aware of the action to take should an allegation of abuse or neglect be made. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.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. 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 environment is well maintained, clean and tidy, with a programme of decoration in place to ensure that it is comfortable for patients to use. EVIDENCE: A programme of decoration was in place. As the Adult Assessment Unit is a short term assessment unit, patients have no input into the decoration programme. Since the last inspection a new carpet has been laid in the corridor on the ground floor. The unit was clean and tidy. There is a separate dining room situated off the kitchenette with a pool table at the back of the room. The main lounge, kitchen and dining area have been decorated in the last 12 months. All patients have individual bedrooms with en-suite facilities. There is one bedroom on the unit suitable for a disabled person. Bedrooms are not homely as they are clinical in appearance. Staff have commented in the past that the Adult Assessment Unit is not a long stay unit and due to the nature of the David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 18 assessments it is not appropriate to become too homely as pictures and ornaments could be used as weapons during ictal/post ictal behaviours. Patients are encouraged to bring in small personal belongings. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.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. 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. There were enough qualified competent staff working on the Adult Assessment unit to ensure that patients are supported. EVIDENCE: Staffing levels were adequate to meet the needs of the patients. Patients were very complimentary about the staff. Comments were made as follows: ‘staff are marvellous’, ‘staff are approachable and know my needs’ The following comment was received by CSCI before the site visit: ‘They are a well trained, greatly experienced team of professionals who work well together’ Registered nurses work on the unit 24 hours per day. The David Lewis Centre operates a recruitment procedure which is based and equal opportunities ensuring the protection of service users. A small sample of staff personnel files was examined. All of the necessary checks have been carried out to ensure that staff are suitable to work at the Centre. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 20 Members of staff spoken with said they are supported with their training. Although there is a training centre on site some members of staff have attended training on mental health outside of the centre. A supervision and appraisal system is in place and all appraisals have been completed. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The unit is generally well run with qualified nurses and care staff providing care and treatment for patients to ensure that their needs are met. EVIDENCE: The manager is a qualified nurse and an experienced manager. A good quality assurance system is in place. This is based on seeking patient’s views regularly. In addition to patients completing questionnaires to give their views of the quality of the service, patients’ meetings are held monthly. Some of the comments made on the satisfaction surveys are as follows: ‘the staff are always friendly and if I had a problem I would approach staff’; ‘my family and myself all thought the unit was like a 4 star hotel, all staff were great towards myself and family’; ‘Cleanliness 110 percent’. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 22 The manager holds staff meetings regularly to discuss any issues and form an action plan as appropriate. Audits are also carried out regularly. The David Lewis Centre’s health and safety officer has responsibility for health and safety training for staff on induction, for updates on training and for risk assessments relating to the houses. The records he held on fire safety training, including phased evacuation, were incomplete and did not correspond with the records held in the individual houses. There was insufficient evidence, therefore, to confirm that all staff are receiving their mandatory fire safety training. There are lengthy delays in referring recommendations and requirements made by the fire officer to the David Lewis Centre’s maintenance department for action. Records are retained in the maintenance department of the completed work but no process is in place to ensure that the work is monitored by the health and safety officer. Fire risk assessments produced by the Centre were completed a number of years ago and reviewed following the fire officer’s visit. The reviews have been written as audits of the premises and should now be supported by a fire risk assessment in line with current guidance. The health and safety officer has an audit programme for the houses to cover fire safety tests, COSHH etc that will take place every 4 – 6 months. However, these haven’t started yet – the first one will take place within the next few months. Accident records are completed in the houses and copies are sent to the health and safety officer to monitor. He collates the information and reports each month to the Chief Executive of the David Lewis Centre. David Lewis Centre Adult Assessment Unit DS0000018800.V321793.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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 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 2 2 3 X 3 X 3 X X 2 X David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 24 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. 1 Standard YA2 Regulation 14 (1) (a) Requirement Timescale for action 30/03/07 2. YA6 15 (1) 3 YA7 12 (2) A full assessment of a service users’ needs must be done by unit staff before the service user is admitted to the unit so that they can judge whether the person needs to be admitted to the unit and that they can meet their full needs. Information on a person’s 30/03/07 seizure pattern must be obtained on admission to the unit and this information must be documented in the care plans. Service users from other 30/03/07 registered premises on site must be fully consulted and their views obtained before they are admitted to the Adult Assessment Unit David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 25 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 David Lewis Centre Adult Assessment Unit DS0000018800.V321793.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI David Lewis Centre Adult Assessment Unit DS0000018800.V321793.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!