Inspection on 16/11/06 for Dolphin View

This inspection was carried out on 16th November 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dolphin View 14/11/08

Dolphin View 22/06/06

Dolphin View 25/11/05

Dolphin View 18/07/05

Dolphin View 02/12/04

Dolphin View 14/06/04

Dolphin View 10/03/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Dolphin View Harbour Road Amble Morpeth Northumberland NE65 0AP Lead Inspector Suzanne McKean Key Unannounced Inspection 13:30 16th November 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dolphin View Address Harbour Road Amble Morpeth Northumberland NE65 0AP 01665 - 713339 01665 713223 dolphinviewhome@fshc.co.uk 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) Cotswold Spa Retirement Hotels Limited (wholly owned subsidiary of Four Seasons Healthcare Ltd) Mrs Susan Davison Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Four named service users are known to be outside category OP. One is category MD(E), one LD(E) and two PD. Should any of the named service users leave the home, the Commission for Social Care Inspection must be notified immediately, at which time these places will revert to the category OP. 22nd June 2006 Date of last inspection Brief Description of the Service: Dolphin View is a purpose built care home with nursing situated on the edge of the harbour in Amble Northumberland. The home is over two floors, which are accessed by stairs and a passenger lift. All the rooms are for single occupancy. None of the bedrooms have en-suite facilities, however each bedroom has a hand washbasin. There are bathrooms, showers and toilets close to residents’ bedrooms and all communal areas. Specialist baths and toilets are provided for residents with disabilities. There are lounges on both floors with the dining room situated on the first floor. There is access to a garden area to the front of the home, which affords views across the bay and harbour area. Car parking is provided to the rear of the building. The home charges fees of between £332.94 and £400.78 per week depending upon the needs and requirements of the individual residents. As the home provides nursing care the free nursing care element of the funding is provided in addition to the costs charged to the resident. The home provides information about the service through the service user guide. A copy of the last inspection report from The Commission for Social Care Inspection is available in the entrance to the home. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a total of 10 hours during two visits. A third visit was undertaken to discuss the outcomes of the inspection with the Manager. Eight residents and four staff were spoken to at some length and others chatted to briefly. Four relatives were spoken to directly as they were in the home. Six care plans, and records for medication were examined. Also staff files, training records and health and safety documentation was looked at. There was sixteen requirement made at the last inspection, thirteen of which have been met. Three requirements are outstanding and additional time has been given to allow them to be met. What the service does well: What has improved since the last inspection? There have been significant improvements since the last inspection. The home has an activities co-ordinator who is working to provide increases opportunities for the residents. The food provided is now more varied at teatime with this to be reviewed again. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 6 There has been improvement to the decoration and fabric of the building and assisted bathing and showering facilities are available to sufficient numbers. Replacement furniture has been provided and a programme of redecoration and replacement is in place. Thermostatic mixing valves have been fitted. Suitable hoists and slings are now available in sufficient numbers and the home is tidy. Control of infection practices and equipment have been improved, there is a sluice disinfector on both floors. The laundry is now well organised and well equipped. Staff files now show recruitment policies are being followed and training programmes ensure staff are able to meet the changing and assessed needs of residents. The registered persons receive formal supervision at least six times a year with records kept. The home is operating good fire prevention practices and the Manager is seeking alternative methods for having residents bedroom doors open if necessary. 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. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a service user guide containing the statement of purpose, which outlines the service provided. Residents have written contracts and terms and conditions of residency. These set out the rights, and obligations of all parties. The resident needs are identified during the detailed assessment carried out both before and after admission and they and their families can be confident they will have their needs met. Residents or relatives can visit the home before making any decisions to stay and receive information to help them make up their mind. EVIDENCE: The home has a service user guide and statement of purpose, one copy of which is in the foyer at the entrance of the home. It contains the services Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 9 provided and good information about what is available from the home and in the local area. One resident spoken to said that he had seen this document. He said that is particularly important as the home has a non-smoking policy and although he does smoke he still chose to move in. Four care plans were inspected and showed that the manager carries out comprehensive assessments before any resident is admitted to the home. The manager then discusses the resident’s needs with the nursing staff including identifying any equipment, which might be needed prior to the admission. The care managers and the nurse’s assessors report were also available. These assessments then form the basis of the care planning process for the resident. Two residents said that they had been invited to visit the home before they decided to move in although one said “my daughter visited it for me, to see what it was like”. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The care planning system provides staff with the information they need to meet resident’s assessed needs. The health needs of residents are currently being met. There is good interagency working between the home and the local NHS facilities. The systems for the administration of medicines are currently safe and consistent. EVIDENCE: All residents have a care plan which includes a detailed assessment and a plan of care. Four care plans were looked examined were of a good standard. Risk assessments are completed for: prevention of falls, wound care, moving and assisting, and there is good care planning around areas such as continence promotion. There is an assessment to look at residents’ food and fluid intake. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 11 Residents access NHS services and facilities as necessary. The care plans showed that specialist advisors are used for individual residents. The home liaises very closely with the General Practitioner who provides care to all of the residents in the home. Health care records are kept in the home and the nursing staff were very knowledgeable regarding the residents needs. The care being given during the visits also showed this for personal and health care areas. The care was being given by staff who showed kindness and were courteous protecting the dignity of the residents. The care plans show that the personal and health care needs of the residents are being met. The social assessment describes the resident’s social needs and there are plans to develop this further. Residents were dressed for the activities they were undertaking and looked smart and tidy. A number of residents were positive about the care being given. Comments made included “you’ll not find anything wrong here” and “I’m happy with my care”. Medicines management was appropriate. The staff record the medicines correctly when they are ordered. The prescriptions are then checked when they are received in the home from the General Practitioners and are then sent to the Chemist for dispensing. The medicines received from the pharmacy are checked against the record of what was ordered and prescribed so that any errors can be picked up. Medicines no longer required are disposed of safely. No resident manages his or her own medication. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The residents are offered some social activities and are encouraged to take become involved in those they find interesting and are able to take part in, and this is being developed further. The residents are being encouraged and supported to maintain contact with their families. The residents are given a balanced, nutritious diet given at appropriate times in a satisfactory environment. EVIDENCE: The manager undertook a relative and resident questionnaire including social activities and food. The outcome of this was discussed at the relatives meeting and it was agreed to make changes to the evening meal. The notes from this meeting were available on the notice board in the main corridor of the home. There has been another meeting with relatives and staff since then. There is now a new activities organiser employed in the home working 15 hours per week. She is dividing her time between group activities and Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 13 individual residents. It will take time for her to become familiar with all of the residents choices and abilities, however residents were very complementary about the work she has begun and described how much they had enjoyed a recent outing. Two residents said that they liked to sit together and chat and another said that she would spend a lot of time looking out of the window watching the people walking their dogs. The residents said that their visitors are always made welcome, could visit at any time and in private. Residents are able to manage their own finances for as long as possible. Information and advice is available about finding advocates if necessary. People are able to bring their own possessions with them from home such as furnishings and keep sakes. This has made their own rooms individualised, reflecting their lifestyles and personalities. The registered manager has carried out a food survey. This was to find out what residents likes and dislikes were for meal times. The teatime menu has been reviewed and some improvements have been made. Three evenings there is soup and sandwiches, two evenings there is a cold buffet, two evenings is a light cooked meal and every evening there are cakes or scones. Although residents spoken to were happier with the choice it is to be further reviewed and improvements will be made if necessary. There is a choice of continental or cooked breakfast and there are alternatives available for the main meal, which is served at lunchtime. On the second day of inspection for lunch, there was a choice of chicken in gravy, or sausages, served with mashed potato, fresh broccoli and frozen mixed vegetables. This was sampled and was tasty and served at an appropriate temperature on warmed plates. The dessert was home made trifle, yoghurt or fresh fruit. Cold drinks were given throughout the meal. The dining room is large and pleasantly decorated. Tables were appropriately set and staff gave assistance when necessary in a sensitive manner. Several of the residents had their meal served to them in their own room. There was specialist cutlery and adaptations available for those Residents spoken to said, “the food is lovely, I’ve put on weight” and “the meals are nice”. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The complaints procedures are clear. Residents are confident that their views are listened to or acted upon. Arrangements for the Protection of Vulnerable Adults are satisfactory and protect residents from harm. EVIDENCE: The home has comprehensive policies and procedures available setting out how to make a complaint. The procedure is displayed on the notice board. The complaints records were clear, and included the investigation and the outcome. The residents and relatives spoken to were aware of the complaints policy and said that they would know who to speak to if they had any concerns. The record of relatives and resident meeting showed them to be complementary about some of the recent changes and had wanted them to be recorded. There are policies and procedures in place for Adult Protection. The staff have received in house training about how to deal with alleged abuse in the last twelve months and this training is ongoing. There have been no “Protection of vulnerable adults” referrals in the last year. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well decorated and maintained and offers the residents a pleasant environment in which to live. The bedrooms are particularly well personalised. Good records are maintained of the health and safety practices and maintenance of the building and facilities. The home is clean and well organised and the training is planned to improve the staff knowledge regarding the ways to prevent the risk of cross infection in the home. EVIDENCE: The location and layout of the home is suitable for the needs of the residents. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 16 The home has had an ongoing redecoration and refurbishment, which has greatly improved the appearance of the home. Residents have access to safe outside garden areas, which have views across the bay and harbour. All of the lounges and dining rooms have been tastefully decorated and refurbished and the residents spoken to were happy with the decoration and suggested that the home was a lovely place to live. The home is a smoke free area. None of the bedrooms have an en-suite facility however; there are toilets, bathrooms and shower rooms close to all resident areas. The home has one electric hoist per floor. There are 13 residents who need to be hoisted split between the two floors. Additional slings have been purchased. The residents all have a single bedroom. The rooms vary in size and all were pleasantly decorated. Residents have been encouraged to bring small items with them making their own rooms highly individualised and reflecting individual lifestyles and preferences. All of the bedrooms have been fitted with suitable bedside lights. The refurbishment of the laundry has been completed. There is now a soiled and clean area with sufficient room for ironing and storing of some linen. The walls and flooring are easy to clean and there is access to a hand wash sink. This area is equipped with washing machines, dryers and ironing equipment. There is now a sluice disinfector on both floors, these rooms were tidy and have hand wash sinks for staff use. At the last inspection the Responsible Individual confirmed that further Infection Control training would be sourced, and this is now ongoing although the training programme is not yet complete. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is an effective recruitment and selection system, which ensures that residents are cared for by well-trained, skilled staff and are in safe hands. The training programme is up to date and covers a large spectrum of both clinical and statutory areas with the exception of moving and handling. Additional control of infection training is currently being provided as agreed at the last inspection. EVIDENCE: The home has staff numbers and skill mix in line with the company’s staffing grid. On the second visit to the home, which was unannounced, the following staff were on duty: 1 qualified nurse 1 senior carer 5 care staff in the morning (4 care staff in the afternoon and evening) There is one qualified nurse and three care staff at nighttime Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 18 Eight of the staff have NVQ level 2 or above. Only 36 of care staff have this qualification. Five staff started foundation training in June 2006. On both of the visits there were staff on duty in line with the staffing levels agreed with the Commission for Social Care Inspection. Staff records are completed according to the company policies and procedures, including two references and a completed application form. The requirement to have a CRB and POVA check is applied to all of the staff in the home. The training records were looked at. There is training in both statutory and clinical areas and staff are given training in line with the company policy. Training provided includes moving and handling, health and safety, skills for care induction, first aid, and food hygiene all of which were up to date. Additional control of infection training is currently being provided as agreed at the last inspection. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Davison has had a period of absence from which she has now returned. She has systems to manage the home effectively taking into account the needs and wishes of the residents. There are effective health and safety systems, which include staff training and risk assessments. Staff supervision is up to date. Resident’s personal finances are managed appropriately, except that there is still a non-interest accruing account for those residents who have money held by the home. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 20 EVIDENCE: There is a system and records to review health and safety. There are records of regular staff meetings and the contents suggest that there is broad spectrum of relevant issues discussed. The Manager continues to consult the residents, staff and other interested parties to review the service provided and manage the staff in a way to improve care delivered. She does regular tours of the building herself when she speaks to residents and relatives, who know her well. She has audits for care plans, medication administration and the kitchen, as well as accident analysis and resident at risk reports, which is a company policy. There have been relatives meetings and the records are displayed on the wall in the main corridor. These are quite well attended and show that relatives are interested in the home. These notes also contain complements from relatives, which they felt they wanted recording. The fire records are up to date and the training is being provided to staff as necessary. There is a system in place for undertaking staff supervision, this is generally up to date although some are due now to make sure that they have an adequate number within the year. The personal records kept in the home of residents who are receiving assistance to manage their finances were examined and are detailed, logical and appropriate. Receipts were in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. There is still a shared bank account in place. However, the administrator has examined the records and has made changes to ensure that all residents who can have their money saved in their own bank account or money taken by relatives where appropriate can do so. There is also a plan to have money stopped from being sent to the home where the local authority is appointee and the resident has sufficient money for their needs. In house maintenance records were up to date and there are contracts in place to ensure regular maintenance and repair of major electrical and gas equipment. The manager is now able to use local tradesmen to provide emergency cover to speed up repair times as necessary. Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP26 Regulation 13,6 Requirement The registered persons must ensure staff are trained in infection control policies and procedures to minimise the spread of infection. Timescale for action 01/02/07 2. OP28 18 The registered persons must 01/04/07 ensure that 50 of care staff are trained to NVQ level 2 or equivalent. The registered persons must ensure that any interest accrued on residents money is paid into their individual account. 01/04/07 3. OP35 17,20 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 Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Dolphin View DS0000000510.V302985.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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