Inspection on 22/02/06 for Elizabeth Peters Residential Care Home

This inspection was carried out on 22nd February 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Elizabeth Peters Residential... 12/06/07

Elizabeth Peters Residential... 30/10/06

Elizabeth Peters Residential... 27/09/05

Elizabeth Peters Residential... 04/01/05

Elizabeth Peters Residential... 27/07/04

Elizabeth Peters Residential... 10/03/04

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

CARE HOMES FOR OLDER PEOPLE Elizabeth Peters Residential Care Home 22 Newquay Road Catford London SE6 2NS Lead Inspector Kate Matson Unannounced Inspection 10:00 22 February 2006 nd 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 Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 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. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elizabeth Peters Residential Care Home Address 22 Newquay Road Catford London SE6 2NS 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) 0208 2440013 Elizabeth Peters Care Homes Limited Ms Agnes Ngobeh Care Home 3 Category(ies) of Dementia (3), Mental disorder, excluding registration, with number learning disability or dementia (3), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (0), Old age, not falling within any other category (3), Physical disability (1) Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home is registered for 3 persons of whom up to 3 may be elderly, up to 3 may be elderly with dementia, up to 3 may be elderly with a learning Disability, up to 3 persons may be elderly with a mental disorder and up to 1 may have a physical disability but be over 50 years of age 27th September 2005 Date of last inspection Brief Description of the Service: Elizabeth Peters House is a small home for three older people who may have a mental health problem or dementia. The home is one of four owned and managed by a local provider, Elizabeth Peters Care Homes Ltd. The home is situated in a quiet residential street close to the centre of Catford. The home is well served by public transport facilities with bus and train services within a short walking distance of the home. There is a small parade of shops close by, with larger shops and facilities available in Catford town centre. There were no vacancies on the day of the inspection though the provider has recently made application for registration for another two bedrooms. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced statutory inspection was completed over six hours. The inspection included discussion with two service users, two visiting relatives, the registered provider, the new acting manager, other staff, a tour of the premises, examination of all of the service users’ files, five staff files and other records. What the service does well: What has improved since the last inspection? What they could do better: Care plans cover only limited areas of service users’ lives and not all relevant aspects as required at previous inspections. This means that some areas of need, for example financial needs, may not adequately be addressed as none Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 6 of the service users had care plans around this although one had support in this area. The home is clean, pleasant and well maintained though a requirement of the environmental health department as well as CSCI that the kitchen be refurbished has remained outstanding over several inspections. Although it is reported that service users are currently managing with the homes environment, an occupational therapy assessment of the premises, as in the national minimum standards, is still recommended to ensure that it can meet service users’ changing needs. Although an acting manager had recently been appointed, the home has not had a permanent manager registered with CSCI now for some time. The health, safety and welfare of service users are protected, the times of fire drills must be recorded to evidence that they are carried out at different times as required. 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. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 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 Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 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 Service users are given all the information they need about the home. EVIDENCE: Previous inspections had noted that the statement of purpose and service user guide were missing some required information. However, at the last inspection it was pleasing to note that service users had been provided with an information pack to keep in their rooms. This included a statement of purpose, service users guide, complaints procedure, fire procedures specific to each service users and their room, and information about advocacy services. The statement of purpose and service user guide included all of the required information as well as some additional useful information. However the service user guide described a wider number of communal spaces than was available in the home. The document needed to be reviewed to ensure that the information supplied to service users is correct. At this inspection it was found that this had been done. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 Care plans do not evidence that all areas of service users’ needs are addressed. The home’s medication systems are safe. EVIDENCE: The home uses a care planning system that facilitates a clear and comprehensive assessment of all aspects of service users needs. At previous inspections it was noted that care plans covered only a few specific areas, the format was not being used correctly and whilst care plans were regularly reviewed and there was evidence of service users signatures, it was not clear what service users had agreed to. Also risk assessments were not available for all service users. At this inspection all three of the current service users care plans were examined. Again one service user only had a care plan covering personal care, another had only a care plan covering mental health and physical health and the third, which the acting manager said she was working on, had care plans covering mental health, physical health, activities and personal care. Only one service user had a care plan covering activities and none had care plans covering finance although one was supported in managing their money. Care plans must cover all relevant areas from those listed under national minimum standard 2. This issue has remained unmet over several inspections and CSCI may consider taking enforcement action. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 10 All three files had risk assessment and a care plan consent form though this should be reviewed to ensure that it shows that service users have been involved in discussions in all areas of their care plan. The homes medication system and records were examined. These were all in order. Some homely remedies were now available in the home with written approval from the GP as recommended at the last inspection. This ensures that service users have easy access to remedies for minor ailments. All staff who administer medication have undergone training and certificates of this training have been seen at previous inspections to cover the required areas. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Service users are happy with the activities offered inside and outside the home. EVIDENCE: At the last inspection service users spoken to were not interested in any organised activities and preferred to organise their own time, reading and watching television. However staff demonstrated that an individual approach is taken to activities and two service users had made progress in the small number of activities they have been prepared to get involved in. One service user goes out once a week with a carer and another service user goes out once or twice every day with a carer. Service users had also been offered a holiday in the summer though none of the current residents had wanted to go. The home had offered trips out in the past and the inspector was informed that a lunch out was being planned for service users. It was recommended that if this was successful, this is offered at least monthly. At this inspection staff stated that service users were participating a little more in activities such as board games and had been on a few trips out. They had been out for several lunches. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 12 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): These standards were considered met at the last inspection. At the last inspection, the following judgement was made :Service users had not made complaints but confirmed they would be happy to if necessary. The home’s practices ensure service users are protected from abuse. EVIDENCE: Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 13 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 and 26 The home is clean, pleasant and well maintained though the environmental health requirement of the kitchen refurbishment remains outstanding. An occupational therapy assessment of the premises is still recommended although it is reported that service users are currently managing with the homes environment. EVIDENCE: Elizabeth Peters House is a small home situated in a quiet residential street close to the centre of Catford. It is a converted property and blends in well with the surrounding buildings and is well served by public transport facilities with bus and train service within walking distance of the home. There is a small parade of shops close by, with larger shops and facilities available in Catford town centre. At previous inspections requirements were made to instigate a significant amount of refurbishment, maintenance and re-decoration work to ensure that the home remains suitable for its purpose, and to develop a programme of routine maintenance and renewal. At the last inspection, it was found that the home was largely well maintained. The bathroom had been refurbished and there was evidence of regular redecoration of the home Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 14 though a routine maintenance programme was still unavailable. However the kitchen still required refurbishment and the environmental health officer had also required this to be done. The provider however stated her intention to refurbish the kitchen but was currently waiting for quotes for a new boiler as she wished to replace this as part of the refurbishment. At this inspection it was found that the home was still generally well maintained but the kitchen was still awaiting refurbishment. The acting manager stated that this was scheduled to take place the following month. This must be completed as a matter of urgency as this has issue has remained unmet over a number of inspections and CSCI may consider taking enforcement action. There is a call system in the home with an alarm facility in every room. There is some equipment available in the home such as handrails on the stairs and a grab rail in the bathroom. At a previous inspection it was noted that although the service users were ambulant, one of the service users had dementia and was likely to become frailer with age. The registered provider was reminded that an assessment of the premises and facilities should be made by suitably qualified persons including an occupational therapist with specialist knowledge of the client groups catered for to ensure that disability equipment provided and environmental adaptations made meet the needs of service users where issues such as physical frailty or dementia are identified. It was recommended that such an assessment take place. At the last inspection the registered provider stated that she had consulted with the GP who had said that this was not necessary and staff confirmed that service users were coping with the environment as it is and all were able to get out of the bath without assistance. However as service users are becoming frailer and the provider is planning to apply for registration for another two service users the recommendation is restated in this report. On the day of the inspection the home was clean and free from offensive odours. However the laundry is sited adjacent to the kitchen and can only be accessed through the kitchen meaning that dirty laundry has to be carried through a food preparation area. The provider had been given contradictory advice by the environmental health department and at a previous inspection was required to request an inspection report from the environmental health department and forward a copy of the most recent report to CSCI. At the last inspection it was found that a report from November 2004 was available and required the refurbishment of the kitchen, the replacement of the kitchen ceiling, and recommended the relocation of the laundry facilities, and food temperature testing. The provider had already replaced the kitchen ceiling and was planning the kitchen refurbishment. She stated that food testing had been taking place but there were no records available to support this. The registered provider was required to ensure that the requirements and recommendations of the environmental health department are met and implemented. At this inspection it was found that the kitchen was still to be refurbished, and new advice from the environmental health department now indicated that a risk assessment completed by the provider regarding food hygiene and the laundry arrangements was sufficient. Food temperatures were now being recorded. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 15 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): 28, 29 and 30 Although the home has a good number of staff trained to and above national minimum standards, the home’s training plan needs to evidence better that training meets mandatory requirements as well as those of staff and service users. The home’s recruitment practices are safe though should better evidence that they are in accordance with equal opportunities policies. EVIDENCE: Of the six staff members on the duty rota, two were qualified nurses, two had recently completed NVQ level 2 training and one was doing NVQ level 3. Therefore the home has more than half of its staff trained to national minimum standards as required. Staff files of five staff members were examined. The files included all of the documents required by regulation and included evidence of the checks made prior to employment. However none of the files included records of interviews, which should evidence that recruitment procedures are in accordance with equal opportunities policies. It is recommended that an interview format be developed to address this. Previous inspections had found that records of staff training were kept and assessments of staff training needs carried out for each staff member. At the last inspection it was found that information from Skills for Care (the national training organisation or NTO) had been obtained and also staff members had been sent on external courses in order to meet a previous requirement that the provider must ensure that the homes training and development programme meets the NTO workforce training targets. It was recommended that in order to demonstrate a proactive approach to training to ensure that Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 16 the needs of staff and service users are fully met, a training plan is developed based on mandatory requirements, the assessed needs of staff and the needs of service users. At this inspection it was found that a training plan had been completed but this did not include sufficient details of how the plan would be implemented, for example the manager was aware that moving and handling and infection control training were areas of need but this was not reflected in the plan. A more detailed plan is now required to ensure that staff fulfil the aims of the home. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 17 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 and 38 The home still does not have a registered manager in post. The home has some effective quality assurance systems in place. Service users do not have care plans in place to ensure that their financial interests are safeguarded. The health, safety and welfare of service users are promoted and protected. EVIDENCE: Previous inspections had raised concerns about the management arrangements at the home as the previous manager was not working full time hours and then was absent from the home due to a bereavement. At the last inspection it was noted that the registered provider had taken over as manager of the home though CSCI had not been notified formally of this as required by regulation and she had not submitted an application to be registered as manager. Prior to this inspection the provider had informed CSCI that due to a problem with the management of another home in the group she was now managing there and had appointed an acting manager at Elizabeth Peters. This issue has Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 18 remained unmet over several inspections and CSCI may consider taking enforcement action. Previous inspections had noted that the home had developed an effective quality assurance system that included satisfaction questionnaires given to service users, visitors and staff. At the previous inspection it was found that results of service user surveys had been included in the service user guide as required by a previous inspection and this made the document a much more personal account of life in the home. It was recommended that the results of surveys of relatives, visiting professionals and staff surveys are also included in the document to give an even fuller picture of the home. At this inspection it was found that this had been done. Also the acting manager stated that monthly unannounced monitoring visits as required by regulation had very recently commenced now that the provider was no longer managing the home although a report was not yet available. One service user manages their money independently, another has support from a relative and the home had recently started to support the third service user, at their request to manage their money. The records of this were in order however none of the service users had care plans covering finance. This must be addressed to ensure that their financial needs are addressed. At the previous inspection it was found that several requirements had been met. These included an electrical installation certificate be sent to CSCI, the requirements of the fire brigade be complied with as soon as possible, persons working at the home receive training in fire prevention, staff involved in food preparation have food hygiene certificates, and there is a qualified first aider on duty at all times. One outstanding requirement was that the registered provider must give notice to CSCI of death, illness and other events as required by regulation without delay. At this inspection it was found that two accidents had occurred at the home though notification had not been made to CSCI, as staff did not feel the events were covered by regulation, however these were completed at the inspection. Other records were examined and indicated that fire equipment, electrical appliances, and gas system were appropriately inspected and serviced and the fire procedures were in order though times of drills were not being recorded to show that these are held at different times. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X 3 X X X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 X X 2 Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15 Requirement The registered provider must ensure that care plans cover all relevant aspects of service users lives, and that the chosen care planning system is appropriately used. (Previous timescales of 30/11/04, 30/04/05 and 31/12/05 not met) The Registered Person must instigate a significant amount of refurbishment, maintenance and re-decoration work to ensure that the home remains suitable for its purpose, and must develop a programme of routine maintenance and renewal. (Partially met, kitchen refurbishment and routine maintenance plan outstanding. Previous timescales of 01/08/04, 30/06/05 and 31/01/06 not met) The registered provider must ensure that requirements and recommendations of the environmental health department are met and implemented. (Partially met kitchen refurbishment still DS0000025593.V284561.R01.S.doc Timescale for action 31/05/06 2. OP19 23 (2) (d) 31/05/06 3. OP26 13 (3) 16 (2) (j) 31/05/06 Elizabeth Peters Residential Care Home Version 5.1 Page 21 4. OP30 18 (1) (c) (i) 5. OP31 8 (1) 6. OP35 12 (1) (a) 7. OP38 23 (4) (c) (iii) outstanding. Previous timescale of 31/01/06 not met) The registered provider must ensure that the homes training plan meets mandatory requirements, sector skills specifications and is based on the assessed needs of staff and the needs of service users. The Registered Person must ensure that there is a full-time or full-time equivalent Registered Manager/s in post. (Previous timescales of 01/07/04, 30/04/05 and 31/01/06 not met) The registered provider must ensure that service users have care plans in place to ensure that their financial needs are addressed. The registered provider must ensure that the times of fire drills are recorded. 30/06/06 31/05/06 31/05/06 31/03/06 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 OP7 OP22 Good Practice Recommendations It is recommended that the care plan consent form be reviewed to better evidence service users involvement in discussion of all areas of the care plan. It is recommended that an assessment of the premises and facilities be made, by suitably qualified persons including an occupational therapist with specialist knowledge of the client groups catered for, to ensure that disability equipment is provided and environmental adaptations are made to meet the needs of service users. It is recommended that an interview format be developed to evidence that recruitment procedures are in accordance DS0000025593.V284561.R01.S.doc Version 5.1 Page 22 3. OP29 Elizabeth Peters Residential Care Home with equal opportunities policies. Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Elizabeth Peters Residential Care Home DS0000025593.V284561.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!