Inspection on 25/04/07 for Duchy Avenue (13)

This inspection was carried out on 25th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 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

Duchy Avenue (13) 19/01/06

Duchy Avenue (13) 17/06/05

Duchy Avenue (13) 24/02/05

Duchy Avenue (13) 06/01/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Duchy Avenue (13) 13 Duchy Avenue Harrogate North Yorkshire HG2 0NB Lead Inspector Caroline Long Unannounced Inspection 25th April 2007 09:30 Duchy Avenue (13) DS0000007882.V335804.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 Duchy Avenue (13) DS0000007882.V335804.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. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Duchy Avenue (13) Address 13 Duchy Avenue Harrogate North Yorkshire HG2 0NB 01423 528208 F/P01423 528208 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) Northern Life Care Limited T/A U.B.U. Mrs Jean Annette Baross Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 4 Service Users with Learning Disabilities two of whom may be over 65 Date of last inspection 19th January 2006 Brief Description of the Service: 13 Duchy Avenue is registered to provide accommodation and personal care to four adults with learning disabilities. The house is a three storey large Victorian terrace and is located close to Harrogate town centre. The home is owned by UBU formally Northern Life Care. The Statement of Purpose and Service User Guide are provided upon enquiry. The Cost of a placement at the home is dependent on individuals needs. Currently charges range from £730 to £765. The cost to the service user is dependent on the level of Local Authority funding and benefit entitlement. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection, this is called a pre inspection questionnaire. Information from surveys that were sent to service users’ and their relatives. Eight surveys were sent out and six were sent back. An unannounced visit to the home. This lasted over four hours and included talking to the support staff and the registered manager about their work and the training they have completed. And checking some of the records, polices and procedures the agency has to keep. Some time was spent with three service users. • What the service does well: What has improved since the last inspection? At the last two visits to Duchy Avenue, the Commission did not ask them to make any improvements. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 6 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. Duchy Avenue (13) DS0000007882.V335804.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 Duchy Avenue (13) DS0000007882.V335804.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): Standard 2 only. People who use the service experience good quality outcomes in this area. People’s needs are assessed before admission to the home to make sure 13 Duchy Avenue is the right place for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions since 2002. The registered manager explained that when an admission occurs information about the prospective service user would be sought from the care manager, relatives and another appropriate sources. This would be followed by visits to the service user by staff to enable them to carry out a full assessment of their needs and to help the service user get to know the staff. Next, the service user would commence visiting the home and spend at least one night in Duchy Avenue before they went to stay permanently. Throughout this process, staff would be sensitive to the prospective service users and their relatives’ needs and the visits would occur at a pace set by the service user. Also, after a settling in period, a review would be held to confirm that the service user is happy with the arrangements. Whether existing service users Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 9 are compatible is given careful consideration and their views are included in this review. Service users are provided with and assisted in understanding the service user guide and contract, which is produced pictorially and kept in their bedrooms. The registered manager confirmed if the assessment identifies any specialist skills the staff need to enable them to care for the service user, training would take place before the service user was admitted to the home. Service users made positive comments about their choice of home examples included; ‘I like it here and I want to stop here’ and ‘it’s the right place.’ Also, two relatives responded in their surveys the home always meets the needs of their relatives. However, it was not possible to look at any admission records, as these had been archived at UBU’s head office, the registered manager explained this was to promote a ‘home’ ethos and stop Duchy Road feeling like an office. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. People who use the service experience excellent quality outcomes in this area. People are involved in decisions about their lives, and play an active role in planning the care and support they receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users said they were very happy in the home and could make choices about their daily lives. During the site visit, staff demonstrated skills in their ability to communicate with service users and an understanding of their individual needs. Staff also displayed both warmth and sensitively when supporting service users to make decisions about their daily routine and where there were elements of risk for service users the staff handled these discreetly and safely. Service users were observed to have very positive relationships with both the registered manager and support staff. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 11 Service users are allocated a key worker, and offered a choice of which member of staff they feel they are able to relate to best. Two service users files were looked at in detail both contained comprehensive and relevant person centred plans about every aspect of the service user’s life. The plans demonstrated involvement of the service user and had step-by-step actions for staff to take to make sure support was provided consistently and exactly how the service user wanted. The service user, registered manager and key worker met regularly to review these plans. To help staff carry this out UBU offer person centred planning training. The plans were supported by personal ambitions; this is where the service user sets a personal target or goal for one year and how they want staff to help them to meet these goals. These had been reviewed with the service user as they had worked towards their ambitions. However, the language used for the headings on the organisations paper work was not always easy to understand or in plain English. An example of this was targeted ambitions. To give service users more control over their lives the registered manager had introduced service users keeping some of their care and financial record in their rooms. Risk assessments had been carried out which help service users to live as independently as possible. The risk assessment had details of the actions service users and staff would need to take to minimise any possible risks, these had been reviewed regularly. The registered manager and staff described the ways they encouraged and supported service users develop their independence. For instance, how they referred to Duchy road as ‘home’ instead of ‘service’ and how service users were involved in assessing the risks in the home for themselves and for others. Where an advocate was needed, some service users would use a close member of their family, for others the local advocacy service would be contacted. The service users have regular house meetings where they decide upon the way they want their home to be run. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. People who use the service experience excellent quality outcomes in this area. People are helped and supported by the staff to make choices about their lifestyle and develop their life skills; this results in them leading a full and active life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff fully promotes Duchy Avenue as the service users own home. Service users are involved in all the household tasks, such as cooking, cleaning, gardening and maintenance checks. During the site visit to the home two service users returned from work based activities, others explained they went into Harrogate shopping, or to the local clubs and the church. They discussed how they had enjoyed a Christmas break in a hotel in Scotland and how they were looking forward to summer break in Llandudno. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 13 Staff and service users explained how routines and activities are service user focused and were easily changed dependent upon service user choices and needs. The service user records gave details of service users preferred life styles and activities. For instance, one plan contained details of how staff supported a service user to learn computer skills, and one gave details of service users religious preferences and how to help the service user to access them. Staff had encouraged another service user to purchase a mobile phone so they could contact a taxi service when they needed one. A relative commented on their survey that staff ‘Always puts my relatives wellbeing first and do not push them into doing things they are not comfortable with.’ Although staff were confident all the service users lifestyle needs were being met, they did explain the amount of one to one time available with service users was reduced due to staff leaving recently. Service users are supported to maintain links with family and friends by staff. Staff and service users explained how they plan for the food at a weekly meeting and how they help carry out the shopping and prepare the meals. Service users will generally eat together on an evening, during the day they will eat as and when they are able dependent upon their activities. On the day of the site visit, service users had chosen steak pie and potatoes for supper and there was a large bowl of fruit on the kitchen table. All service users said they enjoyed the food. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. People who use the service experience excellent quality outcomes in this area. People are encouraged to play an active part in making sure their personal and health care needs are fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All four service users replied in the surveys that staff always treat them well, two relatives surveys also stated the home always gives the care or support to their friend or relative which they have agreed. The person centred plans promoted both sensitivity and respect and gave detailed descriptions how the service users preferred to be helped with personal care. There were many examples of good practice records. The registered manager explained service users could have a GP of their choice. Some had continued with the GP they had before moving into the home whilst others had chosen to move to one closer to the home. The staff Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 15 described how they are encouraging and supporting service users to be involved in managing their own health care and how they had recently supported a service user to attend a Doctors appointment independently. Records are kept of visits by health care professionals these showed GP’s, nurses, chiropody, speech therapist and hospital visits. The registered manager explained service users were being encouraged to self medicate with support. When self-medicating risk assessments are carried out and medication is kept in a locked safe in the service users room and restocked weekly, systems are also in place to make sure they are taking the required dose. For those who need help, medication is kept in a locked cabinet and when dispensed recorded on a medicine administration record sheet. Each service user has a medical information sheet, which has details of the service users medication and all the medication is monitored and checked by the pharmacist. Staff confirmed they had attended medication training. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. People who use the service experience excellent quality outcomes in this area. People are able to express their views and are safeguarded from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is available in the home and complaints forms are available for service users in pictorial format. All four service users surveyed said they knew whom to complain to and comments made by service users were ‘I would tell you or the staff.’ Also, during the site visit service users were observed to be comfortable approaching the manager and staff and making their views known. The residents have regular house meetings and concerns and complaints are always on the agenda. The complaints procedure is given as part of the service user guide, which service users keep in their own room, it is not displayed in the home as this detracts from a normal home environment. There have been no formal complaints to the Commission. Duchy Avenue has had only one complaint from a neighbour about the noise; the registered manager was able to amicably resolve this, this was recorded in a complaints book. To promote good practice and follow data protection guidelines separate records for each complaint should be kept with a log to track where the details are held. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 17 There is a comprehensive policy and procedure with regard to the safe guarding adults and the procedure to take if there is a suspicion of abuse. Discussion with the registered manager showed she was aware of the action to take to safeguard adults. Service users said they felt ‘safe’ in the home. Staff have training in adult protection and safeguarding issues during induction and foundation training and National Vocational Qualifications. Also, the training records showed adult protection training was part of the training programme for April to September 2007. Service users are supported to look after their own finances and each has a safe in their room to put their valuables in. Where service users prefer the staff to look after their money, it is locked away and there is a recording sheet to note down when money is spent and receipts are kept. The registered manager explained how service users holding and being responsible for their own money was far better as it promoted their self respect as they could choose to buy what they wanted, when they wanted without having to ask staff. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 18 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. People who use the service experience good quality outcomes in this area. People live in a clean and comfortable home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Duchy Avenue is a terrace house near the centre of Harrogate, there is a large kitchen and dining area and separate lounge, a bathroom and shower room. There is a small garden to the front and a small yard at the rear where service users can sit out. Duchy Avenue is a home, service users are encouraged to see it as their own and take pride in it. It was clean and fresh one said they enjoyed helping to clean it. Staff encourage service users to carry out a range of checks to make sure the house is maintained and safe. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 19 Generally, the home is decorated to a good standard, however, there were some areas which would have benefited from some refurbishment, the wall paper in the lounge was damaged and a service users bedroom carpet and bed both needed replacing. The registered manager explained these areas of the home were being refurbished, new furniture and curtains have been purchased for the lounge and a new carpet and bed for the bedroom. Service users were happy to show their rooms, which had personal possessions, which reflected their interests and age. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 20 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, 33, 34 and 35. People who use the service experience good quality outcomes in this area. Proper recruitment procedures and good staff training meant that peoples’ needs were met and their interests were safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff displayed both good practice and the necessary skills to care for service users, when interacting and providing support. During the site visit staff and service users were observed to have good relationships, the staff understood the individual needs and preferences of the service users and displayed gentleness, warmth and understanding when talking to them. Also, the service users appeared to like the staff. Staff confirmed they had attended learning disability awareness induction and foundation training when they commenced work and following this National Vocational Qualification level 2 in care. The staff and the records also evidenced other training such as medication, food hygiene, culture; person Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 21 centred care planning, fire safety and first aid had been carried out or were planned for. Service users house meetings had staff training on the agenda and staffing issues. All staff said management encouraged them to keep up to date with their training. Two staff records were looked at both contained all the information and checks necessary to protect service users from abuse. The registered manager explained service users did take part interviewing of staff for the home and all the service users would meet the staff before they commenced. The home is not fully staffed at this time but is trying to recruit a team manager and support worker. There are normally two members of staff during the daytime and one in the evening and one who sleeps over at night. Although staff said they had been able to manage and service users needs were being met, they were aware this did restrict their ability to accompany service users into the community and spend one to one time. The registered manager carries out individual staff supervision every four to six weeks. Staff meetings are held regularly. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 22 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. People who use the service experience excellent quality outcomes in this area. People benefit from a home that is managed in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has worked at and managed the home for a long time; she has her National Vocational Qualification Level Four in Care and Registered Managers award. She was able to describe a clear vision for the home and a sound understanding and application of ‘best practice’. During the site visit service users were seen to be comfortable when approaching her to discuss the home, she always listened and responded with warmth and respect. Staff said they felt extremely well supported by the registered manager. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 23 The home has a formal quality assurance system, which relates directly to national minimum standards and is measured against the home’s improvement plan. Service users are surveyed once a year with a questionnaire that is easy to read, and supported with pictorial responses. The home is audited every month and a report of this audit is forwarded to the Commission. Service users house meetings are held monthly where service users were able to make their view made about their home. The information in the pre assessment questionnaire confirmed that equipment is maintained; gas and electricity supplies in the home are safe and serviced appropriately. Fire detection and fire fighting equipment is tested and maintained and staff regularly trained. The staff explained and the records confirmed service users are encouraged to take part in assessing risks in the home and carry out the regular health and safety checks. Health and safety in the home was discussed at each of the house meetings. During the site visit a service user was helping test the fire alarm. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 24 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 4 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 3 X X 4 X Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 25 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 YA22 Good Practice Recommendations Separate records for each complaint should be kept with a log to track where the details are held. Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Duchy Avenue (13) DS0000007882.V335804.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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