Inspection on 29/05/07 for Elreg House

This inspection was carried out on 29th May 2007.

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 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

Elreg House 22/01/09

Elreg House 18/03/08

Elreg House 11/04/06

Elreg House 05/09/05

Similar services:

1 Marten Road

Daubeney House

Three Gables

Deepdene Care Centre

Aldwick House

49 Glendale

Ferndale Residential Care Home

David Gresham House

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

CARE HOMES FOR OLDER PEOPLE Elreg House 58 Rosslyn Road Shoreham By Sea West Sussex BN43 6WP Lead Inspector Mrs D Peel Unannounced Inspection 10:15a 29th May 2007 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 Elreg House DS0000064568.V336088.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. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elreg House Address 58 Rosslyn Road Shoreham By Sea West Sussex BN43 6WP 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) 01273 454201 01273 453431 elreghouse@aol.com Miss Angela Louise Brown Mr Anthony Robert Brown Post Vacant Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (23) Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only service users age 65 and over may be re-admitted. The total number of service users accommodated must not exceed 23. Date of last inspection 4th September 2006 Brief Description of the Service: Elreg House is a care home registered to provide personal care and accommodation for twenty-three older people who have dementia or a mental disorder. The home is located near to the town centre of Shoreham-by-Sea, West Sussex, with the usual amenities of a small town. Elreg House is a two-storey building with a single storey extension to the rear. Fifteen of the resident’s bedrooms are single and four have the benefit of ensuite facilities. There is no passenger lift. There is an enclosed rear garden that is accessible to residents. The range of fees charged by the home is £411- £600 per week. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. his unannounced inspection was carried out by Mrs Diane Peel on the 29th May 2007. During this visit the intended outcomes for thirty- one standards were assessed; these included the key standards for care homes providing a service to older people. Prior to the visit to the home the inspector reviewed information gathered about the home since it was last visited in September 2006 when an additional visit was made to the home to see to what extent the provider had addressed statutory requirements made at the key inspection carried out in April 2006. The Annual Quality Assurance Assessment was returned to The Commission for Social Care Inspection (CSCI) prior to this visit to the home and this was used to address areas of improvement which the manager and provider had carried out and also identified areas for further improvement. During the visit a tour of the home took place with all communal areas and private accommodation visited. A case tracking exercise for three people living at the home was undertaken to look at how the assessed needs of this group of residents with diverse needs were being met. A visitor to the home to the time to speak to the inspector about their experiences of visiting their relative living at the home and facilities provided. During this visit the records of three staff were inspected and staff were spoken with informally to find out what it is like to work at the home and to discuss aspects of residents care plans and assessed needs. What the service does well: Elreg House provides a relaxed atmosphere and staff were observed to approach people living at the home in a kind and respectful manner. Visitors to the home are made welcome and people’s rights to not see visitors are respected. Meal times are relaxed and staff offer choice when people have sat down for their meal. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 6 A comment noted in the homes own quality assurance questionnaires retuned to the manager was “ the care my mother receives is excellent” and “all the staff are kind and attentive”. The manager and provider have identified areas for improvement and have a commitment to carrying out these improvements. What has improved since the last inspection? What they could do better: Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 7 The manager is aware of the need for improvement in the records of administration of medication. She has agreed that staff needed reminding of the potential for error if records are not completed at the time of administering medication to people living at the home. The manager has identified in the AQAA returned to CSCI that more varied and enjoyable activities could be offered with more time and thought in the planning of individual activity programmes. Areas of the home have been identified by the provider for improvement which includes demolition and rebuild of part of the ground floor accommodation. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 8 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 Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5,6 People who use the service experience good outcomes in this area. People who are considering moving into the home and their advocates are provided with information, have an opportunity to visit the home, and know that their needs have been assessed to ensure that the home will be able to provide the service, which they expect. EVIDENCE: Elreg House has a Statement of purpose and Service User Guide which was observed to be available just beyond the lounge in an area providing lots of information about the home and other information about advocacy services and support services. The copy observed by the inspector was comprehensive and had been updated during 2007. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 10 The Annual Quality Assurance Assessment (AQAA) returned to CSCI reported that the information in the Service User Guide had been improved to give a clearer view of the home and reflect the environmental changes. A visitor to the home who took time to speak to the inspector said that they “came to have a look around and looked at other homes”. They chose this one because “it felt homely and felt right”. There relative had settled in well and there had been no problems. The three care plans viewed at this visit to the home all included an assessment of need undertaken by the manager. Where an assessment had been undertaken through care management arrangements a copy of that assessment was also included. Elreg House does not offer intermediate care. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience good outcomes in this area. Care planning systems have improved and are now person centred so that people using the service know that their assessed needs and changing circumstances will be reflected in their individual plan, but there is the potential for error in the administering of medication by occasional lapses in the recording of medication administered. EVIDENCE: After the last visit to the home the manager introduced a new care planning system, which was observed to be in use at this visit to the home. The care plans and records of three people living at the home were examined. They were observed to be person centred, had been developed from a needs assessment and where possible had involved the person living at the home or a relative or advocate who had signed to show their agreement to the plan. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 12 Care records recorded visits by Doctors, District Nurses, Chiropodists and Opticians and the outcomes to these visits were detailed. There was documented supply of aids and equipment secured by the home for use by individual people. Careful monitoring of peoples dietary intake is made with a record of what people have actually eaten at each mealtime and peoples weight is being monitored. The assistance each person needs with personal hygiene is recorded in their plan of care so that they have the opportunity to retain differing levels of independence. Risk assessments were also observed to be in place and the format of accident reporting had also been improved to assist with being able to identify when accidents/trips and falls are most likely to occur. A night care checking chart has been introduced for night staff to complete at least every two hours and turning charts, observation charts and fluid charts were observed to be in use for people who have higher dependency needs. Care staff spoken with explained that each part of the day has an allocated shift plan where staff are allocated to assist and supervise particular people living at the home. At the end of the shift it is that member of staff’s responsibility to complete the daily records for the people whom they have been assisting. The home had a medication policy, which was observed to be accessible to staff in the carers office. The manager told the inspector that the medication policy had been revised and that all staff are provided with medication training and are required to sign that hey have read the policy. Medication was observed to be stored in two metal trolleys and metal cabinets on the wall. The AQQA returned to CSCI reported that “ a responsible designated person is allocated each shift and is responsible for all medication activity for their shift” and that “the medication keys are signed for on shift changeover”. On the day of this visit it was observed that there were occasional gaps in the medication administration record. This matter was brought to the attention of the manager who checked the monitored dosage system supply to ensure that the medication has actually been given. The manager already has monitoring of medication records on the weekly quality assurance checks and she explained that this error would have been picked up and rectified if she had already done the weekly check. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 13 The manager is aware of the need for improvement in this area and has agreed that staff needed reminding of the potential for error if records are not completed at the time of administering medication to people living at the home. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience good outcomes in this area. Activities are offered and residents are encouraged to maintain contact with their family and friends so that they so that they can satisfy their social and emotional needs. EVIDENCE: The notice board just off the main lounge provides information about forthcoming activities at the home. The preferences for leisure and activities were observed to be recorded in care assessment and care plans. Family trees were also observed in care plans so that staff could be aware of who is and has been important in people’s lives. The AQAA returned to CSCI informed that activities specifically designed for people with dementia are offered including quizzes and regular visits from outside entertainers. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 15 It was observed that peoples religious and cultural needs are taken into account on the assessment carried out before moving into the home and the AQAA states that “service users wishing to have a visiting parishioner is actioned and service users are supported, this also applies to service users wishing to attend church”. The home does not have any restrictions on visiting and the visitor’s book evidenced that there are regular visitors to the home. A visitor on the day of this unannounced visit to the home was observed to be welcomed by the staff and they confirmed that they could visit at any time and was made to feel welcome. The home has a menu board on display in the dining area, which although being in use on the day of this visit, staff confirmed was usually used and showed the choices of the day. The manager spoke about a picture food a bank, which is being put together to help people make choices. At lunch time the atmosphere was relaxed and the majority of people had their meal in the pleasant dining area. Staff were heard to ask people if they wanted the sausage or the turkey for lunch. Both were observed to be served with mash potatoes, cabbage and carrots. Staff were observed to discreetly ask people if they needed assistance with cutting up food and for some who were struggling they sat and provide further help. To ensure that people living at the home are having a sufficient food and a balanced diet records are kept in each persons care plan of what they have actually eaten. These were observed to being completed at all meal times along with fluid charts. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 People who use the service experience good outcomes in this area. The complaints procedure enables those using the service to know that any complaints will be taken seriously and responded to. Arrangements are in place to protect people using the service from being placed at risk of harm or abuse. EVIDENCE: The complaints procedure was observed to be included in the Service User Guide and on display on the notice board. Complaints records were observed and showed that they had been responded to appropriately, recording detail of the complaint, action required and by whom and when. The AQAA returned to CSCI reported that four complaints had been received in the last twelve months of which three had been resolved within twenty-eight days. A visitor spoken with said that they had had no reason to complain and the majority of people returning the homes own satisfaction questionnaires reported that they knew how to make a complaint. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 17 There is a complaint and suggestions box available in the lounge for people’s comments. Elreg House has its own Safe guarding Adults policy, which it uses in conjunction with the West Sussex Multi Agency policy. The homes own policy was observed to have been reviewed in March 2007 and further review in April 2007 was confirmed in the information about policies in the AQAA returned to CSCI. Staff spoken with confirmed that they had had Protection of Vulnerable Adults training earlier this year. Staff records viewed at this visit showed that Protection Of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) clearance is sought for new staff before they begin work at the home. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26, People who use the service experience adequate outcomes in this area. Some areas of the environment are basic but a planned rebuilding project will improve some private and communal areas so that people using those areas have better facilities. EVIDENCE: Elreg House is currently a two-storey building with a single storey extension to the rear. It is located near to shops, railway station and other facilities of Shoreham-By–Sea. Fifteen bedrooms are single and four have en suite facilities. There is no access to the upper floor by lift. The other rooms are for double occupancy and Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 19 the home has a policy for the sharing of rooms, which was observed during this visit to the home. The provider has informed CSCI in their returned AQAA that part of the old existing building is due to be demolished and rebuilt. This will provide six new bedrooms, expansion of the dining area, better laundry facilities and improved bathroom and shower facilities, including a wet room. There are plans to replace all the carpeting on the ground floor including the lounge, which is beginning to look tired and stained. The manager confirmed the replacement of the carpet for the whole ground floor communal areas at this visit. On the day of this visit to the home it was reasonably clean and tidy and there were no unpleasant smells. All areas of the home were visited and a number of areas of concern were brought to the attention of the manager and provider. Two bedrooms doors did not close properly. This matter was dealt with during the course of the visit when the handy man arrived to attend to the doors. There was a window in a ground floor bedroom, which opened outwards. This was a potential hazard for the person occupying this room and the handy man fitted a window restrictor. The kitchen has recently been upgraded and once the new flooring is laid it will be a much improved working area. All rooms had new fixtures for call bells but not all bedrooms had the leads fitted. The manager has agreed that unless the lead is a potential risk to people living at the home all bedrooms should have a call bell which can be used in an emergency by people living at the home, staff attending to people in their rooms and visitors who may need assistance whilst visiting their friend or relative in their bedrooms. During the course of the visit the inspector requested the replacement of a mattress on one persons bed, the piping round the edge had been pulled off and the fibre inside was coming out. The manager arranged for a replacement mattress immediately and this was observed to be in place before the inspector left the home. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience adequate outcomes in this area. People living at Elreg House are protected by improved recruitment procedures and staff receive appropriate training in line with the residents assessed needs. EVIDENCE: When the inspector arrived at the home a replacement member of staff was being sought to replace someone who had rung in sick. Care staff told the inspector that there were usually four carers on duty on a morning shift. A staff rota is available at the home and at busy times of the day such as lunch time the number of staff on duty allowed for staff to assist people who needed help to eat their meal without them being rushed. The recruitment records of three staff were examined at this visit to the home, which included the most recent person employed. They were observed to include evidence of Criminal Record Bureau (CRB) and Protection of Adults (POVA) checks. A job application was on file, two written references, photograph, proof of the person’s identity and completed equal opportunity Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 21 monitoring forms and health declaration forms. Job descriptions were viewed on each file. Each had record of the training that had been attended and any formal qualifications such as NVQ. Evidence of induction, supervision and appraisal was on file for two of the three files observed. There is currently 1 member of staff with an NVQ level 2 or above. This was confirmed in the AQAA returned to CSCI and there was also confirmation that further staff are undertaking N.V.Q’s. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 People who use the service experience adequate outcomes in this area. People living at the home and their relatives can be confident that the manager wants to run the home in the best interests of the people that live there, but to achieve this must identify areas for improvement and act upon them readily so that people have a home where they can feel comfortable and safe. EVIDENCE: The manager has worked at the home since August 2005. The registered provider and the appointed manager have not ensured that the manager’s application had been received by CSCI. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 23 No application has been received and this matter will be followed up by an inspector on behalf of CSCI. The manager told the inspector that she is already undertaking the N.V.Q Level 4 Registered Managers Award. Since the last visit to the home the manager has introduced some improved practices at the home which included the Quality Assurance system in use which surveyed people living at the home, their friends and relatives and other interested stakeholders such as Doctors who visit the home. The manager told the inspector that the home does not handle any monies for the people that live there. Any additional expenditure, which is not covered in the fees, is invoiced direct to the person’s advocates or relatives. There are weekly checks on the environment to check for hazards but these had not identified hazards observed by the inspector: Two bedrooms doors, which did not close properly. This matter was dealt with during the course of the visit when the handy man arrived to attend to the doors. The manager told the inspector that the Fire Officer had not commented upon the doors on a visit recently. There was a window in a ground floor bedroom which when opened outwards was a potential hazard for the person occupying this room. The handyman was also attending to this matter during the visit. Not all bedrooms had call bells with the leads fitted. She has agreed that unless the lead is a potential risk to people living at the home, all bedrooms should have a call bell which can be used in an emergency by people living at the home, staff attending to people in their rooms and visitors who may need assistance whilst visiting their friend or relative in their bedrooms. Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 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 2 3 2 3 2 2 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP19 OP38 Regulation 13.2 Requirement Timescale for action 01/06/07 Staff must sign for medication at the time of administering the medication. 13.4(a)(b) Unnecessary risks to the heath 01/07/07 (c) and safety of people living at the home and working at the home must be identified and addressed according to risk. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elreg House DS0000064568.V336088.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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