Inspection on 25/11/05 for Egmont Road (31)

This inspection was carried out on 25th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Egmont Road (31) 08/12/06

Egmont Road (31) 09/09/05

Egmont Road (31) 07/03/05

Egmont Road (31) 29/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Egmont Road (31) 31 Egmont Road Sutton Surrey SM2 5JR Lead Inspector David Pennells Unannounced Inspection 25th November 2005 15:30 Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 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 Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 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. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Egmont Road (31) Address 31 Egmont Road Sutton Surrey SM2 5JR 020 8661 5534 020 8661 5694 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) Care Management Group Limited Mrs Lesley Somerville Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation to allow one specified service user aged 17 to be accommodated during his transition to adulthood. 9th September 2005 Date of last inspection Brief Description of the Service: 31 Egmont Road is owned, managed and staffed by the Care Management Group (CMG). The project has been open since August 2003 and is registered with the Commission to provide residential care for up to six adults (generally aged 18 - 40) with learning disabilities - who may have challenging behaviour, autism and / or other complex needs. The home itself is a large semi-detached house (attached to a separate ‘sister’ CMG home) situated in a quiet suburban area of Sutton, and within easy walking distance of the town centre with its shops & leisure facilities - and thus also having access to good public transport links. Accommodation within the home comprises of six single occupancy bedrooms all with en-suite facilities (toilet, basin and shower). Communal space is composed of a main lounge, a separate dining area, kitchen, laundry, office, sensory room and a conservatory. A garden is provided at the rear with its own patio area directly off the conservatory at the house level, the garden being down a flight of steps. There are sufficient numbers of additional communal bathroom / shower and toilet facilities located throughout the home, in addition to the en-suite facilities. A vehicle is provided for use by the home. There is a hardstanding at the front of the home for the parking of two vehicles off-road, with free (though often scarce) parking available directly outside the house on the street. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector called in to the home late on afternoon – when most service users were at home and soon after all were back in, ready for the evening. Adequate staff members were in evidence on duty and the manager was able to assist the inspector in reviewing the requirements and recommendations from the last report, other current vital documentation and to tour the home checking out the premises. The inspector was able to observe and engage with the majority of service users during the visit - and he is grateful to them, the staff present and the manager for their cooperation, welcome and hospitality during the visit. What the service does well: What has improved since the last inspection? The home has had some trellis fencing installed to assist in protecting adjacent neighbours from the intrusion of items being thrown by service users into their gardens. The dining room : kitchen hatchway has been opened and reinstated to enable the safe preparation of meals by staff without unpredictable intrusion by service users – some of whom have preoccupations with kitchen items. Suitable storage space has been provided for a service user who has a habit of destroying clothing when they have access to it. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 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. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 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 Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 5. The home provides a comprehensive Statement of Purpose which ensures that all necessary information about the service is available both for service users and others enquiring about the home. Prospective service users can be confident that they will have the opportunity to find out about the home, to visit (including staying for short periods) and – through adequate assessment and consultation - be assured that the home can meet their needs prior to making a firm decision to stay. Service users will receive a contact in a communication strategy suited to their needs - and this ensures that all ‘terms and conditions’ are known and recognised from the point of confirmation of the contract. EVIDENCE: The above first and third judgement paragraphs cover standards 1 and 5; the middle statement is the judgement from last time’s inspection when the three central standards were all found to be met. The Statement of Purpose for the home is a very comprehensive document holding all necessary information as required by the revised Standards, Schedules and Regulations. Important elements – such as the service user’s contract (standard 5) is presented in a ‘Symbols’ style – to enable service users to engage with this part of the document as much as possible. The Complaints procedure is also clearly stated in symbols. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8. The home maintains care plans and assessment documents designed to ensure that the needs of service users are met in a focused and individual way, with their rights to individuality and self-expression being protected, and the wishes and aspirations of the service user being taken into account. Consultation with service users relies on both direct contact and also a broader approach of checking with relatives and carers as well as professionals. Service users can be assured that risk-taking will be an integral part of the support / protection plans put in place by the home, though attention must be paid to ensuring that such risk assessments are introduced / kept up-to-date at all times. Service users and relatives/friends can be assured that information about service users is kept in line with best practice and data protection legislation. EVIDENCE: The above judgement statements are brought forward from the last inspection document – save from the second paragraph, which covers Standard 8 which was not covered at the last visit. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 10 Efforts to ensure that the service is as close to individual service user’s wishes as possible relies both on contact directly with the service user, and on the accrued day-to-day knowledge of the service users. Observations by staff members of service users’ behaviours and reactions, consultation with relatives and former carers, and input from professionals who may well be able to help develop strategies to ‘access’ a service user’s deeper thoughts – all help to develop a full picture. Staff admitted this is sometimes evolved through ‘trial and error’. The majority of service users relate little to each other – the level of interaction is generally low, except for encounters between them that are often attempts to draw attention, nonetheless, to themselves - not the object of their (sometimes challenging) behaviour. Decision-making for the community is therefore a complex strategy – seeking the best for all whilst respecting individual’s rights to opt out. The manager and staff team achieve an excellent fine balance here. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 14. Service users can be assured that the service provides opportunities for them to engage in activities both within and outside the home, and to adopt a lifestyle best suited to the individual. Service users are encouraged to engage with - and are considered by the home to be part of - the local community and are encouraged to exercise their rights in this regard, through proactive use of local community leisure facilities and resources. Relatives / friends can expect a positive welcome from the home, within the context of respect for a service user’s own choices and decision-making. Service users can expect to be provided with a good standard of nutritious and wholesome food – meeting dietary needs and ensuring that mealtimes are a pleasant and enjoyable time. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 12 EVIDENCE: The above judgement statements - save for the second, are taken from the last inspection report which found all the standards met, save for those relating to Standards 13 & 14 - which are reported on, here, in the second judgement paragraph and detailed below. Service users are positively encouraged to enjoy and engage with appropriate opportunities presenting themselves in the local community – both ‘main stream’ and within the local learning disability community. Service users regularly engage with leisure pursuits such as swimming, bowling, attending the cinema and organised Discos are very popular. Opportunities for exercise – be this walking in the park (Morden Hall / Oaks Park / Richmond Park) or engaging in some shopping around Sutton Town centre or other shopping venues (often associated with a stop for coffee or lunch) all contribute towards focused activity. Contact with local Churches is encouraged – though the elements of service user’s challenging behaviour can sometimes create a strange / difficult dynamic in ‘formal’ settings. The house also has a good relationship with their neighbouring (sister CMG) home and they sometimes jointly share activities (such as Christmas and birthday parties, etc.). Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21. Service users can be assured that their personal, health care and emotional needs will be recognised and met by the home’s assessment and care planning programme. The systems adopted by the home regarding medication ensure the safety and consistent treatment and support for each service user. The home makes every attempt to ensure that details are available to ensure that crises - such as a service user being taken seriously ill or passing away are dealt with in as sensitive and personal (and knowledgeable) a way as is possible. EVIDENCE: The first two judgement statements above are taken from the previous inspection report; where all standards inspected were met. The final paragraph reflects on the scrutiny of Standard 21 examined this time. The home makes every effort to encourage a service user’s relatives or carers to be clear about steps that should be taken in times of crisis / extremis. It is accepted that some may not wish to face such prospects – however preplanning is reassuring and helpful to all concerned at a point of emergency. A good format to record the information is in place and the manager does encourage relatives / carers to record their wishes in this regard. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23. Service users can be confident that their comments and complaints are responded to, with appropriate action taken. The home provides support to service users to ensure that they are protected from harm and any form of abuse, however the policy and procedure relating to investigating allegations of abuse and dealing with vulnerable adults does not blend in with the local authority procedure adequately – thus putting service users at possible risk of mishandling of such situations. EVIDENCE: The first judgement paragraph covers the last inspection’s assessment concerning complaints – which was satisfactorily met. The second standard review last inspection contained a recommendation requesting that the registered provider take urgent steps to ‘tie in’ the CMG Adult Abuse policy with that of the host local authority (London Borough of Sutton – a newly revised procedure has been issues in 2005). This has not been done, and the inspector is concerned that the two policies do not concur. The ‘current’ CMG policy (April 2002) does not cover immediately reporting the issue directly to the local social services care management team – a protocol that is now established with all care providers within the Borough (and common to other Boroughs too). Although half the staff team has now attended training on Vulnerable Adults issues – and more is planned soon – the possibility of confusion and therefore potential delay of correct reporting and seeking advice puts service users at potential risk from mis-management of such a situation. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users may expect the home to be clean and a pleasant & comfortable environment to live in, though the special needs aspects of the very individual service users resident at the home sometimes require more timely attention to accommodation issues. EVIDENCE: The above judgement statement – taken from the last report – highlights the continuing need of ‘timely action’ to ensure the special needs of service users are met. The inspector was pleased to note that, externally, trellis fencing has been installed to avoid some problems of distressing neighbours unnecessarily through this simple barrier. The inspector noted that the requirement to reinstate the kitchen: dining room hatch had been heeded and staff members were now able to provide a safer system of servicing food through to service users - with a consequently reduced chance of danger through unpredictable behaviour. Outstanding issues from the last inspection report included the ongoing wait for the installation of blinds in the conservatory, the installation of a suitably Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 16 safe, and permanent heating / cooling system in the conservatory, and the installation of an extractor fan in a service user’s bedroom. A further issue, consequent on the issuing last inspection of an immediate requirement notice to the home concerning the risk of scalding, has arisen. The possibility of risk of scalding from hot water has now been reduced (if not totally eliminated) by the installation of a limiter valve on the hot water supply system – however this leads to very ‘chilly’ warm water temperatures and other issues, such as the lack of pressure to some points in the house – along with the problems encountered by the neighbouring ‘sister’ home in the hot water / heating supplies they received from the same boiler - leads the inspector to require that proposals to ‘split’ the system into two separate entities must be proposed to the Commission by the timescale quoted (31/01/06). Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 36. Service users can rely on the home providing adequate staff in sufficient numbers and duly competent and well-trained to provide a service that seeks to meet their identified needs. The home’s recruitment and staff support mechanisms are organised so as to ensure the safety, protection and wellbeing of service users. Service users can rely on the staff members having sufficient clarity of role and support from senior staff through 1:1 supervision - that the service will be delivered with competence and well-informed proficiency. EVIDENCE: The above judgement statements, excepting the last, were taken from the previous inspection document – where standards were found met. The third paragraph covers the Standards 31 & 36 – both being met at this inspection visit. The inspector was able to inspect a variety of job descriptions attached to the personal files - which evidenced that the staffing structure is well thoughtthrough and supported the aims of the house. The staffing structure runs from manager, through a deputy role to team leaders and then two grades of senior and two grades of support worker. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 18 Examination of staff files at random evidenced regular supervision input to staff – this providing for any subjects to be raised by the staff member and for performance and training issues to be examined. Staff at the home have recently renewed their training in the ‘dignified management of conflict (‘Dig Man’) – the company’s all-important course in dealing with challenging behaviour. NVQ training is still being pursued; four or five seniors are undertaking Level 3 training, whilst four support workers are engaged in the NVQ at level 2. It is hoped that once the current staff undertaking this training have ‘completed’ their portfolios, the staff team will be trained to the proportion required by the standard. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards were inspected this time. Service users and their relatives / friends can rely on the home being run well, and providing a professional service with the best interests of the service user being central to the care provision. The registered providers can be relied upon to take seriously issues raised for their attention – to the benefit and for the safety of those residing at the home. EVIDENCE: The above judgement statements are brought forward from the previous report. The manager and deputy manager remain the same and staffing continues to be remarkably stable. The inspector has no concerns about the general management of the home and refers the reader to his previous report. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X 3 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X X X X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Egmont Road (31) Score X X X 3 Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000046244.V269519.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13(6) Requirement The registered provider’s policy with regard to adult abuse must be amended to accurately tie in the approach required locally under the jointly agreed (and newly-revised 2005) London Borough of Sutton Vulnerable Adults Procedure Guidelines. (Previous report’s ‘strong recommendation’ not actioned.) Timescale for action 31/01/06 2. YA24 16(2)(c) & Vertical blinds must be provided 23(2)(i) to ensure that the office and conservatory are both protected from the excessive summer heat and to provide additional insulation in winter and also confidentiality and privacy to the home from any intrusion. (Timescale of 15/09/04 and 15/11/05 not met apparently the blinds were ready for installation, but pending funding being put ‘up front’.) 23(2)(p) The heating problems at the home require resolution; the current configuration - being interlinked with the neighbouring DS0000046244.V269519.R01.S.doc 15/01/06 3. YA24 30/01/06 Egmont Road (31) Version 5.0 Page 22 (separate) service – is unacceptable as in reality neither home is served well by the joint system. Proposals to ‘split’ the system must be proposed to the Commission by the timescale quoted. 4. YA24 13(4) & 23(2)(p) Freestanding electric heaters 15/01/06 must not be used within the home - due to the dangers of service users / staff tripping over cables, and the lack of protection afforded to such heaters. Additional heating / air conditioning must be provided in the conservatory from a hardwired, fixed and protected source. (Timescales of 30/07/04 & 15/11/05 not met.) An extractor fan must be installed in the service user’s bedroom where there are protected / ‘sealed’ windows due to their unpredictable behaviour. (Timescale of 15/11/05 not met.) 15/01/06 5. YA26 23(2)(p) 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 YA23 Good Practice Recommendations It is suggested that – to supplement the manager giving information to those without the training, - the remaining Vulnerable Adult Protection training be undertaken in a ‘block’ at the home for all untrained staff. A minimum of 50 of the care staff team must be DS0000046244.V269519.R01.S.doc Version 5.0 Page 23 2. YA31 Egmont Road (31) qualified - nominally to NVQ Level 2 in Care - by 2005. 3. YA37 The home’s manager must be qualified to NVQ Level 4 in Management and Care - by 2005. Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Egmont Road (31) DS0000046244.V269519.R01.S.doc Version 5.0 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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