Inspection on 13/09/06 for Eastham

This inspection was carried out on 13th September 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 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

Eastham 08/08/07

Eastham 31/12/05

Eastham 29/06/05

Eastham 12/01/05

Eastham 19/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Eastham Main Road Woodham Ferrers Chelmsford Essex CM3 8RF Lead Inspector Diana Green Draft Unannounced Inspection 13th September 2006 10:00 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 Eastham DS0000028664.V312462.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. Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eastham Address Main Road Woodham Ferrers Chelmsford Essex CM3 8RF 01245 320240 01245 427243 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) runwoodhomes.co.uk Runwood Homes Plc Mrs Marion Linda Hatcher Care Home 25 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (25) of places Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 25 persons) One named person, over the age of 65 years, who requires care by reason of dementia, whose name was known to the Commission in February 2006 The total number of service users accommodated in the home must not exceed 25 persons 31st December 2005 Date of last inspection Brief Description of the Service: Eastham is a detached period property situated in the rural village of Woodham Ferrers, approximately two miles from the town of South Woodham Ferrers with all its main amenities. This home cares for a total of 25 older people with a range of dependency levels from semi-independent to high dependency. The aim of the home is to provide a homely environment where service users are supported and encouraged to exercise their rights by suitably trained staff. The home has been adapted to meet the needs of older people that include the provision of ramps for easy access and a full passenger lift. Bedroom accommodation is on the ground, first and second floors and consists of nineteen single and three shared rooms. The house is set in well-maintained gardens with views over open countryside and has adequate parking facilities at the front. The fees range from £395.29-£416.08 weekly. Additional costs apply for chiropody, toiletries, sundries, hairdressing and newspapers. This information was provided to the CSCI on 13/09/06 Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 13/09/06, lasting 5.5hours. The inspection process included: discussions with the registered manager, deputy manager, five staff, the cook, eight residents and three visitors; a partial tour of the premises including a number of residents’ rooms, bathrooms, communal areas, the kitchen and the laundry; and inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Twenty-six standards were inspected and three requirements and one recommendation made. Action had been taken to address previous requirements. The manager and staff were welcoming and helpful throughout the inspection. Comments received from residents and their representatives were: “Can’t fault it really”; the food is very good”; “we go to the pub sometimes and have a meal there”; ”I’ve had meals here and they are excellent”; ” the staff are superb, I can’t speak highly enough of them”; the staff are always smiling”; “everyone is included”. What the service does well: What has improved since the last inspection? Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 6 Repeat requirements had been actioned including the provision of an entrance gate that was locked to ensure residents’ safety. Staff had received training in Protection of Vulnerable Adults. 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. Eastham DS0000028664.V312462.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 Eastham DS0000028664.V312462.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, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Residents had the information needed to make an informed decision. The assessment process was robust and ensured residents’ needs could be met. This home does not provide intermediate care. EVIDENCE: A revised statement of purpose was provided. Both the statement of purpose and service user guide reflected the aims and objectives of the home. The statement of purpose was made available to prospective residents and was displayed in the entrance of the home together with the service user guide and previous inspection report. Feedback from relatives confirmed they had a written contract with the home. Eastham had a local admission policy and procedure. This included a standard that all assessments were to be completed within 48hours of admission. Three residents’ care files were inspected. All had a comprehensive assessment that included all elements of need and had been completed within the timescale. Copies of care management assessments were held on file on those sampled. All care files included a plan of care developed from the assessment. Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 9 This home does not provide intermediate care. Eastham DS0000028664.V312462.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 site visit to the service. There is a clear and consistent care planning system in place that provides staff with comprehensive information and ensures residents’ needs are appropriately met. The health care needs of residents are well met with evidence of good liaison with health care professionals taking place on a regular basis. The systems for administration of medicines are good with clear and comprehensive procedures in place that are well adhered to and ensure residents’ safety. EVIDENCE: Three care files were inspected. Each contained care plans that covered all key needs (physical and social), provided good detail of the action required of staff to meet residents’ needs and were reviewed monthly. Two relatives spoken with said they had discussed and agreed the care plan and this was confirmed by their signature. Feedback obtained from relatives indicated they were always kept informed about important matters and always consulted about their care. Risk assessments for moving and handling/mobility, pressure areas, Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 11 continence needs and nutritional needs and falls were recorded in the files inspected and had been regularly reviewed. Daily records were detailed and evidenced good monitoring of care needs with appropriate action taken where required.The home was well supported by district nurses who were in frequent attendance at the home to provide nursing treatment. Residents were registered with three local GP practices. However the manager said that discussions had been held with one practice who had offered to provide a weekly surgery at the home with a practice nurse and residents would have the option of transferring if they chose. Records confirmed that regular chiropody treatment was provided and residents attended outpatients and had access to other healthcare services as needed. One resident said that they could not fault the care, and another said that care staff were “really very nice” when providing personal care. Another residents said “the staff are kind and helpful and available day and night”. Medication was stored in a trolley that was secured to a wall and housed in a cupboard. Monitoring of temperatures showed that temperatures were at times above 25°Centigrade as recommended. Action had bee taken in consultation with visitors and the commission to change the use of the visitors’ room to a dedicated medication /clinical room with air conditioning and to accommodate controlled drug storage. There was a drug refigerator currently stored in the kitchen and regular temperature monitoring was in place. The home had medication policy and procedures that were available for staff guidance. The deputy manager/care team managers administered all medication at the home and had all received appropriate training. Medication was supplied through the local pharmacist in pre-dispensed packs and appropriate ordering and disposal procedures were followed. Medication administration records (MAR) were well recorded. Advice was given to ensure that for prescribed creams, only the person administering the cream must confirm by signature. Temazepam was stored as a controlled drug as acknowledged to be good practice. One relative spoken with said their loved one’s health had improved since they were admitted to the home because there was good monitoring of health needs and their medication was given on time. Residents spoken with said that staff treated them with respect and ensured their privacy and dignity were upheld. As there was no designated hairdressing room and no electrical point in the bathroom, arrangements had been made for residents to have their hair dried in other residents’ rooms. A care assistant said this was to ensure their dignity. However this also compromised the privacy of the residents whose rooms were being accessed, and neither had their agreement been sought. (standard 14) Eastham DS0000028664.V312462.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 good. This judgement has been made using available evidence including a site visit to the service. The social and therapeutic activities offered at the home met residents’ cultural needs and expectations and enhanced their daily lives. Visitors were warmly welcomed into the home. The home provided residents with a wellbalanced and nutritious diet with choices acommodated EVIDENCE: Eastham had two activities coordinators. A social activity information file had been compiled for prospective residents and relatives that included photographs of the various events that had been organised at the home. Friends of Eastham organised regular fundraising events that were also social events for residents. Links with the local community included school choirs who visited to entertain residents during the festive season. Information on activities was included in the statement of purpose and those provided included games and quizzes, weekly seated exercise, art and craft, sing a long evenings and cooking days. Outings organised included pub outings, day trips, shopping trips and visits to school trips and libraries. Regular communion and church services were held at the home and representatives of various faiths attended as needed. Visitors spoken with said they were always made to feel welcome at the home and arrangements were made for them to have lunch Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 13 with their loved one on request. One relative said that there had been a lovely barbecue and fete held in the summer and everyone, including those residents in wheelchairs were included. A group of residents spoken with said they sometimes went to the pub and had a meal there and really enjoyed that. Residents spoken with said they were encouraged to get up and to eat in the dining room but could choose to take part in activities and to go on outings or to spend their time with friends they had made since coming to Easthams. Several residents were having their hair done. However due to the size restriction of the home, there was no designated room available and residents were observed having their hair dried in other residents’ rooms (standard 10). Meals were served in the one of two dining rooms where tables were pleasantly laid with table cloths, condiments, cutlery and drinking glasses. One relative said that they had previously had meals at the home and they were excellent; “served nicely”, “properly, and with dignity”. The menus observed were balanced and nutritious and detailed the nutritional values for each day and week. The lunchtime meal of roast beef, mashed or roast potatoes, carrots and green beams was sampled and the meat was tender. Residents spoken with said “it’s lovely”; “it’s very nice”; “I always enjoy the roast dinner”. Staff were observed to assist residents who required it in a senstive and dignified manner. Care plans and nutritional records inspected detailed weight monitoring and action taken as needed. Eastham DS0000028664.V312462.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 site visit to the service. Appropriate policies, procedures and practices were in place to promote the protection of residents from abuse. Recent updated training provides assurance to residents that these will be adhered to. EVIDENCE: The home had a complaints procedure that included the timescales within which complainants can expect a response and advised them of their right to refer to the CSCI at any stage. The procedure was included in the statement of purpose and displayed in the entrance of the home. One complaint had been received since the previous inspection that had been invetigated and reported as indicated in the procedures. The home had a suggestion box to collate all issues of concern and the manager encouraged feedback from residents and relatives. Procedures had also been implemented to ensure that all concerns were documented and used to improve standards. The home had a comprehensive policy and detailed procedures for safeguarding vulnerable adults. All staff had received updated training since the previous inspection. Records inspected showed that appropriate prerecruitment checks on new staff were undertaken prior to appointment (see standard 29). Eastham DS0000028664.V312462.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, 22, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. Eastham was safe, well maintained and had a very homely environment; residents’ rooms were individually furnished and equipped for their safety, comfort and privacy. The gardens to the rear of the premises are not accessible to residents or wheelchairs users. The home was clean and hygienic with safe infection control practices that were in the main well adhered to. EVIDENCE: A partial inspection of the premises was made that included communal areas, several bathrooms, a number of residents’ rooms, the kitchen, the proposed clinical room, the sluice and the laundry. The home was in a reasonable state of maintenance and repair. Records provided evidence that the building complied with the requirements of the local fire and environmental health department. The home had grab rails, ramps, hoists and other mobility equipment to meet the needs of residents. Wheelchairs were provided and were well maintained. Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 16 Pressure relief equipment was assessed and provided by the district nursing service as needed. The premises were observed to be clean and hygienic throughout. An issue in one resident’s room was being dealt with. The manager had sought advice from the Communicable Disease Control Nurse with regard to infection control. An audit had been undertaken and action taken to address any potential shortfalls. The manager said that infection control was discussed at supervision to ensure practices were reinforced and adhered to and this was confirmed from a tour of the premises and observation of staff with exception of the kitchen. The kitchen had screens fitted to the external door but there was no screen fitted to the food server hatch. Attempts had been made to secure window nets but this was not adequate to prevent flies entering the kitchen. The rear door screening had also been left open to allow air to circulate as it was uncomfortably hot. However this had also enabled flies to enter the kitchen. The laundry was small and there were no separate clean and soiled routes. However it was clean, well organised and fitted with two washing machines and a tumble drier. Appropriate hand washing facilities were in place and safe practices were observed. Eastham DS0000028664.V312462.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 good. This judgement has been made using available evidence including a site visit to the service. Staffing levels were adequate to ensure the safety of residents. Staff recruitment practices were thorough and protected service users. There was a training programme in place that provided staff with appropriate skills to care for residents. EVIDENCE: There were 24 residents and 1 resident who was in hospital. Staffing levels were confirmed at: AM – 1 senior care assistant 3 care assistants PM – 1 care 3 care assistants Night 1 care team managers 2 care assistants. The staffing levels were adequate to meet the needs of residents. The home had ten care staff who had NVQ level 2, which is 44 of the total staff workforce. The staff files confirmed that all new staff received induction to Skills for Care standards. The files of three recently employed staff were inspected: these contained evidence that all the required checks had been obtained (two satisfactory references, CRB/POVA checks) and evidence of ID had been obtained before the individuals commenced employment at the home. All had received a statement of terms and conditions of employment. All staff were provided with a copy of the General Social Care Council Code of Conduct on appointment. Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 18 The home had a comprehensive training programme in place. Records summarising training were seen, and showed that most staff were up-to-date with all mandatory training including health and safety, fire safety, basic first aid and moving and handling. Training had also been provided in dementia care, protection of vulnerable adults, care planning, control of substances hazardous to health (COSHH), equal opportunities . Eastham DS0000028664.V312462.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, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Easthams is well managed and run in the best interests of residents. EVIDENCE: Feedback from relatives indicated their perception that there was an ongoing improvement at Easthams. The registered manager had managed the home since June 2005 and had several years experience in working in care of older people. She had commenced the Registered Managers Award training and had undertaken regular updated training relevant to a care home for older people. Residents and relatives spoken with said they found the manager very helpful. The home had a quality assurance framework in place that included an annual quality audit from which an annual plan was developed. Progress from this was Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 20 monitored by regular monthly visits undertaken by a senior manager and a six-month quality monitoring review. Complaints/compliments were monitored with appropriate action taken. The home obtained feedback from staff, residents and their relatives through regular meetings, a suggestion box and surveys. Policies and procedures inspected were regularly reviewed and was run in the best interests of service users. All residents had an advocate/representative to manage their finances on their behalf. Personal allowances were held for some residents and accurate records were maintained to ensure the safe keeping of money held on their behalf and to ensure they received the appropriate allowances. Records held on behalf of residents were kept up to date and stored safely in secure facilities in a locked office in accordance with the Data Protection Act 1998. Records viewed at this inspection included: care plans, medication records, statement of purpose, service user guide, staff recruitment and training records, maintenance records, accidents/incident records and fire safety records. The home had a health and safety policy statement and there was evidence from the records and in discussion with the manager and staff that safe working practices were in place. Action had been taken to provide a gate to the entrance of the site that was kept locked to ensure residents’ safety All accidents, injuries and incidents were well-recorded and appropriate action taken. Eastham DS0000028664.V312462.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 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 X X 3 X X X 2 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 3 3 3 Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 22 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. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 30/09/06 2. OP10 12(4)(a) 3. OP26 13(3) The registered person must ensure that prescribed creams are confirmed by the signature of the person who administers the cream. The registered person must 31/10/06 ensure that residents’ rooms are not accessed for hairdressing without their agreement. The registered person must 31/10/06 ensure that action is taken to prevent flies accessing the kitchen. Screening must be fitted to the food serving hatch. 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 2 Refer to Standard OP38 OP19 Good Practice Recommendations The registered person should review the kitchen ventilation. The registered person should provide planting and seating in the rear garden with access for wheelchair users. DS0000028664.V312462.R01.S.doc Version 5.2 Page 23 Eastham Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Eastham DS0000028664.V312462.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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