Inspection on 16/06/08 for Drumconner

This inspection was carried out on 16th June 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Drumconner 24/08/06

Drumconner 18/10/05

Drumconner 18/05/05

Drumconner 07/02/05

Drumconner 06/07/04

Drumconner 08/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Drumconner 20 Poole Road Bournemouth Dorset BH4 9DR Lead Inspector Jo Palmer Unannounced Inspection 16th June 2008 10:40 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 Drumconner DS0000020451.V362072.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. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Drumconner Address 20 Poole Road Bournemouth Dorset BH4 9DR 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) 01202 761420 01202 762158 info@drumconner.co.uk Drumconner Homes Limited (Bournemouth) Mrs Helen Margaret Colley Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (6), Physical disability of places over 65 years of age (4) Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 25 service users in need of nursing care may be accommodated. A maximum of 4 service users in the category PD(E) and 6 in the category PD may be accommodated at any one time. These service users may require either nursing or non-nursing services. 24th August 2006 Date of last inspection Brief Description of the Service: Drumconner cares for up to 35 people in an attractive period house. It is set back from the busy main road that runs between Westbourne shopping area and the town centre of Bournemouth. The home is surrounded by an attractive garden and some parking is available. The home is on 3 floors with a passenger lift between the ground and the first, and a stair lift and several stairs leading to the 2nd floor. There are a variety of aids and adaptations around the building to allow residents to move about more independently. There are 27 single rooms, fifteen of which have en suite facilities. The remaining 4 rooms are all doubles with en suites. There are additional communal toilets and bathrooms around the home. The current weekly charge at this home ranges between £775 and £975 -social care rates plus primary care trust funding. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The inspection took place on 16th June 2008 between 10.40 and 15.20. Helen Colley, registered manager was present who assisted with the inspection process. The main purpose of this key inspection was to check that the residents living in the home were safe and properly cared for and to review the homes performance against the key National Minimum Standards and in addressing the two requirements of the last inspection. The inspector spoke with five residents and the manager, took a tour of the premises and examined relevant records. The Commission for Social Care inspection sends each home an AQAA (Annual Quality Assurance Assessment) at the start of each inspection year, Drumconner’s completed AQAA was reviewed to further inform this report after the inspection visit to the home. What the service does well: The home understands the importance of ensuring they have all the information necessary concerning a person’s health and welfare prior to them moving in. All new residents receive a full comprehensive needs assessment before admission, records demonstrate this is undertaken sensitively. The manager ensures the home has obtained a summary of any assessment undertaken through the care management arrangements with the assisting local authority. Based on assessment information prior to the person moving to the home, a care plan is devised detailing how care needs are to be met, care files are regularly reviewed and updated to ensure care can be delivered satisfactorily and that all care needs are addressed in the daily routines. Residents at Drumconner have access to healthcare services from local surgeries and are supported in meeting appointments with other health care professionals. Medication is well managed in the home. People living in the home are encouraged to make choices and decisions about their own lives and are able to pursue their preferred level of activity and recreational pass-times, the views of residents are sought regularly through reviews, resident meetings and surveys and the manager strives to implement any requests as they arise. Residents maintain good levels of contact with friends and family and the local community. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 6 Residents living at the home are protected by the home’s safeguarding policies and can be assured that any concerns or complaints will be taken seriously and acted upon. The home provides comfortable, clean and very well appointed and maintained accommodation that meets residents needs. There is a selection of communal areas, according to the numbers of residents, this means that residents have a choice of place to sit quietly, meet with family and friends or be actively engaged with other residents. There are sufficient numbers of trained staff on duty to meet resident’s needs; the recruitment process ensures that all staff employed are suitable to work with vulnerable adults. Drumconner is well managed and Mrs Colley has a good understanding of the principles and focus of the service, Mrs Colley is supported by the home’s senior staff team and it was evident from discussion that the management systems are transparent. 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. Drumconner DS0000020451.V362072.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 Drumconner DS0000020451.V362072.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A pre admission procedure is in place and assessments are routinely undertaken to ensure that only residents whose needs can be met by the home are offered places there. EVIDENCE: Three resident care files were reviewed, each of these contained assessments undertaken prior to the person moving to the home. The pre-admission assessments demonstrate that all aspects of the person’s health and welfare needs are identified in order to establish whether Drumconner can meet those needs. It was evident also that the person being assessed and their carers, were involved in the process of assessment. The pre-admission assessment format has been reviewed since the last inspection to ensure that the requirements of the Mental Capacity Act are addressed Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice EVIDENCE: Following from an assessment prior to admission, the resident moves to Drumconner where further, more detailed assessments are undertaken using set, well established assessment criteria. All aspects of the persons health, welfare and personal care needs are considered and a plan of care identified instructing staff on how the needs are to be met. Care plans demonstrate that each aspect of the persons daily routine is considered and made known to staff in order that they may assist them correctly and provide specialist support where needed. Care records are well organised, consistent and rational with each assessed need being followed by an action plan. Each aspect of the care plans are reviewed regularly to ensure any changes to the residents health is identified and made known to staff. Helen Colley, registered manager Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 10 confirmed that in addition to written care plans, residents needs and how these are to be met throughout the day are also identified to staff daily at each shift handover where discussions take place concerning resident’s progress and general well-being. Staff record daily the care they have provided and although sometimes brief, this record demonstrates that each area of the care plan has been implemented, the record also identifies any other significant events for the resident such as appointments, visitors, social activity etc. Records are also held on each residents care file demonstrating that staff at Drumconner monitor each persons health regularly in order to feed into the care planning process and reviews and to keep abreast of any changes, records are held of residents temperature, pulse, respiration, blood pressure, weight, dietary and fluid intake etc and any changes are noted and action taken appropriately. It was evident that residents can have access to their records should they so wish although Helen Colley stated that they rarely ask, records are written respectfully Medication records are well kept and evidenced that residents are in receipt of any medication as prescribed by their GP, storage of medicines in the home was safe and in order. Medication administration records were seen to be in order, well kept and with clear instruction. A record is kept of the safe return to the pharmacy of any medication that is no longer required. Medicines are issued in their original containers, the containers are dated when opened to ensure an accurate audit trail can be maintained. Residents spoken with said that they were treated well and that staff were kind and friendly. Staff were seen to treat residents with courtesy, patience, kindness and respect. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to enjoy a fulfilling programme of activity either individually determined or group activities with a variety of resident focussed options to choose from as far as their individual abilities allow. The home has sought the views of residents and considered their varied interests and abilities when planning the routines of daily living and arranging activities. Routines are flexible and residents are encouraged to make informed choices. An activities coordinator is responsible for creating meaningful activities for groups of residents or individuals; visitors are welcome at any time. Food is considered to be highly important and meal times considered a social occasion for those able to use the dining room. The cook in the home is experienced in cooking for older people, is an important member of the care team and is aware of the dietary and needs of each resident. The menu is varied, balanced and nutritious and includes choices with a vegetarian option. Food is served to meet the needs of residents including those who have swallowing or chewing difficulty. Staff give assistance to those service users who need help to eat. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care files examined evidenced that resident’s social care and recreational needs are taken into consideration through assessment to care planning. Residents spoken with during this inspection confirmed that their social needs and expectations were met. Records held relating to residents daily lives in the home confirmed that they maintain contact with their friends and family and visitors are welcomed to the home. Although vacant at the time of inspection, an activities coordinator post has been recruited to, the previous holder of this position organised suitable activities both in and outside the home and the newly appointed person, due to start work at Drumconner the week following inspection will take over these duties; activities include musical entertainment and trips out to the beach, local garden centres and shops. Drumconner also has a complimentary therapist who visits weekly to carry out treatments such as aromatherapy and reflexology. Three monthly resident meetings take place for which minutes are taken and a news letter is produced, this gives residents the opportunity to express their views and contribute to the homes operation. The returned AQAA (Annual Quality Assurance Assessment) completed prior to this inspection identified that social care could be further improved by the provision of a computer for resident use and introduction of a snack bar. Residents are provided with three meals a day, breakfast by individual choice, the main midday meal and supper from a menu offering choices and providing a variety of nutritious and appetising dishes; residents can take their meals in the homes dining area or in their rooms. The home has two cooks who work shifts over each weekly period; one post is currently vacant although has been covered by an agency chef who is known to the home. The cook spoken with during the inspection was enthusiastic and keen to provide a good service and was knowledgeable about resident’s dietary requirements. Residents spoken with without exception highly complimented the provision of meals in the home. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies, procedures and staff training programmes are in place to protect the residents living at the home; residents can be assured that they can express any concerns they may have and that any incidents will be managed appropriately. EVIDENCE: The last inspection reported that a complaints procedure is available to residents and visitors to the home; this was not reviewed as Mrs Colley confirmed that it has not changed and also confirmed that no complaints have been received. Adult protection procedures are in place detailing the correct action to be taken should any concerns or allegations be made. The home holds a copy of local authority and Department of Health guidance on adult protection matters and all care staff have received training in adult protection and recognising abuse; no referrals have been made. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to see the home as their own home. Drumconner is well maintained, safe, comfortable and attractive and has specialist equipment and adaptations needed to meet individual resident’s needs; all staff members are trained in the safe use of aids and equipment. Fifteen of the rooms have en-suite facilities and shared bathrooms are comfortable, easy to use and very well appointed, assisted and unassisted showers and baths are available. There are a number of toilets placed around the home. There is a selection of communal areas and residents have a choice of place to sit quietly, meet with family and friends or be actively engaged with other residents. The home operates an infection control policy, is kept clean and well maintained, and provides an effective laundry service. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 15 EVIDENCE: Residents spoken with confirmed that they are comfortable in their rooms and are able to bring personal effects to make their space more homely; a tour of the premises viewing some rooms evidenced this and that they were clean, well maintained and homely. Many bedrooms have en-suite toilet and wash facilities, shared bathrooms are available with suitable aids and adaptations to assist residents and toilets are sited conveniently around the home. All bathrooms and toilet areas seen were decorated and fitted to a very high standard. All resident areas have emergency alarm call points should they be needed by residents requiring assistance. Communal areas of the home include lounge areas and a dining room, these were noted to be furnished and decorated to a high standard, clean and comfortable. The home was clean and well maintained at the time of inspection; infection control procedures are in place with suitable hand washing facilities for staff in respect of infection control procedures. Residents spoken with confirmed that the laundry systems in the home work well and that their clothing, bedding etc is returned promptly, clean and in good condition, the laundry area was seen briefly, this area in a separate building from the main home includes large, commercial washing machines with programmes capable of sluicing and high temperatures, and large commercial tumble dryers. A laundry person is employed to ensure the smooth operation of this service. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have confidence that the staff at the home are able to meet their needs. Rotas show that the home is staffed efficiently and the staffing structure is clearly defined. Management are aware of the benefits of a skilled, trained workforce and invest in training programmes to ensure all staff are up to date. There is a good recruitment procedure that is followed in practice for the protection of residents. EVIDENCE: Staff rotas seen demonstrate that there are sufficient numbers of staff on duty to meet residents needs; residents confirmed that staff are available when they need them. There are two first level registered nurses, 2 or 3 senior care assistants and 3 or 4 care assistants on duty each shift. At night there is one first level registered nurse and 3 health care assistants. Staff training files seen demonstrated that each staff member undertakes training and regular up dates in mandatory subjects relating to health and safety such as moving and handling, infection control, food hygiene, first aid, health and safety and fire safety. Additionally, clinical updates are undertaken Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 17 to ensure that the trained staffs registration remains current and that they continue to meet residents needs. Mrs Colley confirmed that all new staff undertake the ‘Skills for Care’ induction programme although staff files only held record of some of the units, it has been recommended that a record is held relating to all units of the induction programme. Staff files examined also demonstrated that good practice is used when recruiting staff, all mandatory checks are undertaken and pin numbers are verified. No staff member commences employment before a satisfactory POVA check and CRB have been carried out. Mrs Colley confirmed that now 50 of health care staff have achieved a level 2 NVQ award and a further two are undertaking this training. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are can be confident that the home is well managed and that systems are in place that centre around their care needs. Management practices and records kept, confirm the health and safety of people in the home. EVIDENCE: Mrs Colley, registered manager of Drumconner is a first level registered nurse and a competent manager who is able to efficiently run the home with the support of a cohesive staff team. Residents spoken with confirmed they were happy with the management arrangements stating that Mrs Colley and the staff were available when needed. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 19 The Commission for Social Care Inspection send all care homes an AQAA (Annual Quality Assurance Assessment) at the start of the inspection year (April). A completed AQAA which provided detail of the home’s intention to continue to monitor and evaluate the quality of service provided was submitted which identifies what the home feels they do well and sets out their plans for improvement over the next twelve months. Mrs Colley has distributed surveys to residents, relatives, visiting professionals and other interested parties, results of these have been audited and demonstrate the views of stakeholders. Resident meetings are held and minutes kept and a newsletter is produced and made available to residents demonstrating recent and planned events in the home and information for residents. It is advised that the significant points of the AQAA are used to inform the homes Quality Assurance report that is available for residents along with a précis of the internal audits carried out and the newsletter. Residents can be assured of effective management of their personal finances, where a resident requires assistance with their allowances; the home ensures that procedures are in place for their protection. Records seen demonstrate that income, expenses and balances are recorded; receipts for expenditure are numbered and logged to ensure a clear audit is kept. A Fire Risk Assessment had, at the time of inspection just been reviewed, the report of which was not yet available although confirmation was seen evidencing that this had been carried out by a contracted, qualified person. Other records were seen relating to regular testing and maintenance of fire fighting equipment, alarms and emergency lighting systems and all staff receive fire safety and awareness training regularly. Risk assessments are in place on resident’s files demonstrating action necessary to reduce or eliminate identified risks such as accidental scalding and falling, choking, moving and handling and hoisting and use of bed rails. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 4 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP30 Good Practice Recommendations It is recommended that a record is held of all units of the Skills for Care induction programme as they are undertaken by staff within their first six weeks of employment. Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Drumconner DS0000020451.V362072.R01.S.doc Version 5.2 Page 23 - 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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