Inspection on 29/08/07 for Development Centre

This inspection was carried out on 29th August 2007.

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

Other inspections for this house

Development Centre 15/05/06

Development Centre 06/10/05

Development Centre 10/05/05

Development Centre 21/09/04

Development Centre 27/11/03

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

CARE HOME ADULTS 18-65 Development Centre Dorincourt Dorincourt Oaklawn Road Leatherhead Surrey KT22 0BT Lead Inspector Kenneth Dunn Unannounced Inspection 29th August 2007 09:15 Development Centre Dorincourt DS0000013626.V347591.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 Development Centre Dorincourt DS0000013626.V347591.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. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Development Centre Dorincourt Address Dorincourt Oaklawn Road Leatherhead Surrey KT22 0BT 01372 841334 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) dominic.lodge@developmentcentre.org Queen Elizabeth`s Foundation Mr Stuart Fleming Care Home 43 Category(ies) of Physical disability (43) registration, with number of places Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. From time to time the home may admit service users over the age of 65 years. 31st October 2006 Date of last inspection Brief Description of the Service: The Development Centre is a purpose built residential care home set the countryside in the outskirts of Leatherhead Surrey. The home offers accommodation to 43 people with physical disabilities, in the category of younger adult. The service has recently undergone a process of redevelopment of some of the buildings. The centre is continuing with its plans for redevelopment both physically and philosophically. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was unannounced and took place over five hours. Mr. Kenneth Dunn, Regulation Inspector, undertook the site visit on behalf of the CSCI. The registered manager was not on duty on the day of the visit therefore Mr Andy Kenny (Placement Manager) represented the establishment. A full tour of the premises took place. Discussions with people who use the service (residents) and staff were held informally and formally to canvass their experiences of the home. The placement manager, occupational therapist and 2 members of the Life coach team were also spoken to. An annual quality assurance assessment (AQAA) was supplied to the home by CSCI, and this was completed and returned. Information from the AQAA will be referred to in this report. The AQAA states that the home has policies and procedures to promote equality and diversity and all staff have received training, to increase their knowledge and awareness of these issues. In addition the home has a set of policies and procedures that have been designed to safe guard the rights of the residents in gender and lifestyle choices. The final report takes into account detailed information provided by the registered provider and the plaement manager that included an Annual Quality Assurance Assessment (AQAA), returned surveys (next of kin, medical professionals, care manger and any other interested representatives of the residents) in addition any information that the CSCI has received about the service since the last inspection will also be used to complete this report. Fees for the service range from £53,320.00 to £75,000.00 per annum. The Commission for Social Care Inspection would like to thank the residents, relatives, manager and staff for their hospitality, assistance and co-operation with this inspection. What the service does well: The service provides people with an individual approach to care, meeting their needs and creating an atmosphere where people feel fully integrated into the home and can make choices in their lives, which they prefer and which promotes their independence. The cultural and diverse needs of people living in the home has been assessed and action taken to meet these needs where possible. Staff working in the home are fully aware of the needs of people living in the home, understand their likes and dislikes and can communicate on different levels taking into account their abilities. Development Centre Dorincourt DS0000013626.V347591.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. The summary of this inspection report can be made available in other formats on request. Development Centre Dorincourt DS0000013626.V347591.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 Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2and 5 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning are good ensuring prospective service users’ needs are assessed before admission to the home. Individuals written contract/statement terms and conditions with the home were in place but were not available in resident’s files. EVIDENCE: The Development Centre had a robust policy on assessing the needs of all potential new residents. The services placement manager informed the inspector that all potential residents would only be admitted to the home following a full assessment of their needs. A review of records confirmed the home had a pre-assessment form including a proposed care plan which covered personal care, health needs and social support. The inspector noted evidence of joint care assessments with the care department, occupational therapists and the life coach team involved in carrying out assessments to safeguard the welfare of the individuals. The residents all have individual contracts with the service however a sample reviews of six residents files highlighted that the requirement from the previous CSCI visit (15/05/06) for copies to be made available on the individual files has not been actioned. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 9 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): Standards 6, 7and 9 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning have been improved. Decision making in the home is complicated because of the size of the service and the impute sources. The systems for risk taking are good and promote the independence of the residents. EVIDENCE: The Development Centre has a full set of policy and procedures to assist the staff to plan and develop individual care plans for all residents. A member of the care support team stated that the individual care plans were developed in conjunction with the individual residents and that the final document was discussed and agreed by the key worker and the resident. A review of the records confirmed care plans were comprehensive and detailed. However as was found during the previous site visit by the CSCI there were some gaps where residents have not signed confirming their agreement to their plan and risk assessments. A requirement was made in respect of this and a timescale set (15/07/06) for full compliance, this requirement remains open. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 10 There was clear evidence of reviews being undertaken and the care plans are updated accordingly, however again the residents or their representatives have not sign the new plan. The care support team enable the residents to make decisions about their lives with assistance as needed. The residents are encouraged to participate in various forums and groups to discuss their individual care needs and help plan plans for the future development of care provision within the centre. In addition the residents have the support of the Occupational Therapists and the Life Coaches to assist and support them to make effective decisions about their lives. The inspector was informed that the centre had a policy on risk taking and a review of records confirmed that risk assessments were in place and that they were dated and signed by staff. Further evidence confirmed risk assessments promoted independence in the areas of personal care and the use of the various forms of transport available to them for community access. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 11 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): Standards 12, 13, 15, 16 and 17 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for education and occupation are well designed and developed. Community links ensure the residents are part of participate in the local community, Their cultural and diverse needs are also fully assessed. The systems for relationships are robust. The daily routines are good ensuring the individual’s rights are respected in their daily lives. Meals at the home are good and offer variety and choice. EVIDENCE: The residents are given a range of opportunities to participate recreational, educational and social activities both internally and externally. The centre employs life coaches to ensure that the activities are based on individual preferences of the residents. The key role of the life coaches is to look at the future needs of individuals and in partnership with the individual residents they help develop a learning plan to promote their independence and any future Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 12 development potential. The learning plan sampled were signed by the residents and showed evidence of regular reviews. A life coach informed the inspector that on average every learning plan would be reviewed every 4 months this can be undertaken more regularly depending on the individual. At the time of the visit the life coaches were supporting 7 residents to engage in employment or collage courses. The cultural and diverse needs of the residents living in the home have been assessed and action taken to meet these needs where possible. One resident has a new advocate and is building a meaningful and valued relationship with this person. The placement manager stated the home had a visitor’s policy and visitor’s information was available in the service user guide. A review of records confirmed that relatives visited the centre regularly and some residents are supported to go home regularly to spend time with family and friends. The centre has a Sexuality and Personal Relationship policy (dated September 2006) this offers guidance and assistance for the residents and staff to follow to ensure the appropriateness of relationships. In addition the centre encourages the residents to participate in one of the personal relationship group. The resident meet in gender groups to discuss and understand what is meant by a healthy and appropriate relationship and to seek a forum to discuss and seek advice. The inspector was informed that the groups have been very successful and have helped the residents to maintain and progress healthy friendships and relationships both inside and out with the centre. The residents have full access to all public areas of the centre, the inspector was informed that unless for health and safety reasons there are no access restriction in place. During the visit the inspector observed the staff and the residents interact in an appropriate manner, which was professional and friendly. One resident stated that the staff are all “very friendly and helpful”. The staff were seen to respect the privacy of the residents and knocked on the doors of the residents before being invited into the room. The development centre has one large dining room for both the residents and the staff to sit and have a meal. The centre employs a full time chief and it is his responsibility to design and develop a healthy living menu for everyone at the centre. The menu sampled by the inspector was well designed and offered the “customers” choices and could accommodate specific preferences and any special dietary requirements. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 13 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): Standards 18, 19, and 20 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care and healthcare support and assistance was well planned and was seen to be provided in a professional respectful and sensitive manner. Sound policies and practices are in place for the administration and management of medication. EVIDENCE: The centre had a schedule for each resident that was reflective of their routines and the routine of the centre with times for getting up, personal care and meals. Observations confirmed the residents had good personal hygiene and were appropriately dressed to reflect their personal choice. A key worker system is operated within the centre this ensures that the resident’s health care needs are fully supported. A review of 5 residents files demonstrated that they are all in receipt of a full range of health care, community nurse, physiotherapy, occupational therapy, and chiropody dentistry and that they are all registered with a local GP. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 14 The inspector was informed by one of the centres occupational therapist that the staff assist and support the residents in a number of health related groups i.e. testicular and breast cancer awareness. The system for medication administration was seen and was generally carried out to a high standard. The Medication Administration Record (MAR) sheets were seen and no gaps in the recording were noted. Risk assessments are carried out to establish if a resident can self medicate, the assessment seen were detailed and comprehensive. The risk assessments are all stored in one central file and if not restricted to any one specific resident. Therefore it is recommended that a copy of the risk assessment be placed in the individual resident files. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 15 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): Standards 22 and 23 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All required policies, procedures and practices are in place to ensure that residents are safeguarded, as far as reasonably possible, from harm or abuse. EVIDENCE: A set of comprehensive complaints policies and procedure was available and accessible to residents. The policies and procedures were reviewed and found to be written in a user-friendly format. Written comments received from residents indicate that they are aware of who they can approach if they wanted to make a complaint and their rights to take a complaint out with the centre to their care manger, the CSCI or any other agency. One resident stated that he was happy with the support he has received from staff but if they did not help him in the way he felt to be appropriate he would complain to the manger. The inspector was informed that 3 complaints have been made since the previous CSCI visit. The CSCI was informed by the centre of the complaints as part of the Development Centres complaints policies the complaints were investigated by the centre and was dealt with appropriately. There is a clearly written safeguarding adults procedure and a copy of the local authority safeguarding adults from abuse policy was available. The contact details for the local authority Social Care Team was also displayed throughout the centre. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 16 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): Standards 24 and 30 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a well-maintained, comfortable, homely and safe environment. The resident’s bedrooms are designed to promote their independence. The home is clean and hygienic ensuring that service users have a pleasant home to live in. EVIDENCE: A considerable amount of work has been carried out to the fabric of the Development Centre since the previous CSCI visit. The bedrooms and bathrooms situated in the Meadway corridor have now been decommissioned and no longer offer residential facilities. The area formally known as the JAC unit has been completely renovated and is now a self contained six bedroom training flat with a large kitchen area and a very spacious sitting room and six bedrooms all with en suite wet rooms. However at the time of this visit the JAC unit was still unfurnished and had not allocated the rooms to any individual. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 17 Some residents showed the inspector their bedrooms each room is individually decorated and residents are supported to choose the colour schemes to suit their preferences. The premises were found to be clean and hygienic, all staff to be congratulated on the cleanliness of the homes. All areas in the home have had paper towel dispensers fitted, to ensure the risk of cross infection is eliminated. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing is under review. The ratio of staff to residents was appropriate for the number of residents living in the centre on the day of the visit. All interactions observed between staff and residents evidenced a high degree of respect and skill in working with the individual residents at the centre. EVIDENCE: The inspector was provided with copies of duty rotas, which indicated that there were adequate staffing levels on duty for the numbers of residents living at the Development Centre. The staff are supported to undertake a series of mandatory and additional training courses. The inspector sampled the training records for 10 members of staff it was evident that they had received mandatory training in safeguarding adults, fire, food handling, food hygiene manual handling, health and safety, first aid, fire protection and managing medication. The Development Centre has a policy on recruitment and retention of staff recruitment files stored in a locked cupboard to promote confidentiality. A Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 19 review of records confirmed staff have completed application forms, written references, statement of terms and conditions, job descriptions, health questionnaires, training records, personal details and CRB (Criminal Record Bureau) disclosure information to safeguard the welfare of service users. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management approach in the home provides an open, positive and inclusive atmosphere. The home has a quality assurance and monitoring system in place that is based on seeking the views of the residents. There is clear evidence of that the residents best interests are paramount to the core values of the home. The health safety and welfare of service uses is protected. EVIDENCE: The manager has a great deal of experience of working with young adults with complex care needs and has undertaken further training and development to ensure that he can offer effective care to the residents. Both his colleagues and the residents described the manger as being very open and accessible and “he is willing to see the other persons side of an issue” one member of staff Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 21 stated, “that he was very reflective and open to be persuaded is it is appropriate”. Staff meetings take place and notes were sampled. Five members of the staff team confirmed that there have been some improvements and changes and the home is “now going in the right direction again”. The residents have been giving the opportunity to participate in one of the many new group forums, which have been introduced or promoted. The forums are fully minuted to maintain openness and continuity these were sampled by the inspector and supported the statement from staff that the residents have a high level of impute during these groups and are supported to be open and frank. In addition to the various forums open to the residents they are also supported to participate in the monthly homes regulation 26 site visits, which comprises of a full audit of the home and designed to highlights areas for improvement and review. The records observed on the day of the site visit were found to be well documented and kept up to date. This included certificates for the testing of Legionella, gas, electrical and a number of other areas tested. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 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 X 33 X 34 3 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 X 3 3 X 3 X 3 X X 3 X Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 23 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 YA5 Regulation 17(2)Schedule 4 Requirement A copy of resident’s contracts must be supplied on individual files. (Previous timescales of 15/06/06 not met) Care plans must be agreed and signed by residents. (Previous timescales of 15/07/06 not met) Timescale for action 15/09/07 3. YA6 15(2)(a) 15/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations A copy of the residents self medication risk assessment be placed in the individual resident files. Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 Development Centre Dorincourt DS0000013626.V347591.R01.S.doc Version 5.2 Page 25 - 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. 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