Inspection on 17/05/05 for Essex Park 49

This inspection was carried out on 17th May 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 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

Essex Park 49 30/09/09

Essex Park 49 21/10/08

Essex Park 49 26/10/07

Essex Park 49 04/07/06

Essex Park 49 02/11/05

Essex Park 49 02/11/04

Essex Park 49 03/06/04

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Edenvale

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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 49 ESSEX PARK Finchley London N3 1ND Lead Inspector Tola Akinde-Hummel Announced 17 May 2005 at 10.00am 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 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 Stationary 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. 49 ESSEX PARK Version 1.10 Page 3 SERVICE INFORMATION Name of service 49 Essex Park Address 49 Essex Park, Finchley, London N3 1ND Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8346 3860 020 8346 3860 essexpk@walsingham.com Paul Snell for Walsingham Community Homes Shirley Deane PC Care Home Only 6 Category(ies) of LD Learning Disability registration, with number of places 49 ESSEX PARK Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 2 November 2004 Brief Description of the Service: Essex Park is a home for six adults with learning disabilities. The home is owned and managed by Walsingham conmmunity homes, an organisation which provides special needs housing in other parts of the U.K. The home is a detached, two storey building, located in a pleasant residential area of Finchley, North London. It is close to shops and many other amenities. Service users bedrooms are located on the ground and first floor. The communal lounge, dining rooms and kitchen are located on the ground floor. There is a large attractive garden at the rear of the property which is accessible to service users. A car is provided for the purpose of taking service users out on various shopping trips and excursions. The stated aim of the home is to enable service users to experience community life, by providing up to date information about the local community projects and facilities, and supporting service users to use them. 49 ESSEX PARK Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over six hours. There were three service users at home over the period of inspection although two people went out and one returned during the time the inspector was there. The inspector was able to speak briefly to two service users. The inspector was unable to communicate with one service user. The inspector was able to speak to three members of staff in confidence and was assisted by the manager Ms Sally Smith throughout the day. The inspector looked in detail through records and toured the building. There were three staff including the manager on duty in the morning and three staff including the manager on duty in the afternoon. Only one service user was in the house for the duration of the inspection. There is currently one vacancy in the home which the manager will consider filling once the home has bedded down most of its policies and procedures. The inspector did not receive comment cards from any relatives or professionals in relation to this home. The inspector would like to thank service users, staff, and the manager who took part in the inspection. What the service does well: What has improved since the last inspection? 49 ESSEX PARK Version 1.10 Page 6 There have been some improvements since the last inspection particularly around the maintenance of the building. Non slip flooring has been provided in the shower room and a rusty radiator has been replaced. Exterior work to the building has been completed and woodwork has been re decorated. The clinical waste bin now is appropriately stored. The storage and administration of medicaction has greatly improved offering clarity to staff and the security of a robust system to service users. Staff believe they have a sympathetic ear in the manager and believe she understands the pressures of caring for service users with complex needs. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 49 ESSEX PARK Version 1.10 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 Standards Statutory Requirements Identified During the Inspection 49 ESSEX PARK Version 1.10 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 standard(s) 1,2,3 Essex Park has not been assessed on these standards as no new service users have entered the home for the past nine years. The manager assures the inspector that should any new service users enter, these standards would be followed. EVIDENCE: Essex Park have recently updated their statement of purpose and this includes all the elements required to comply with the standard. Essex Park currently have five service users living in the home. These service users have lived here for nine or more years. No new service users have been admitted. Due to the length of time that service users have been resident in the home, it is not possible to evidence if service users had visited the home prior to admission. However the manager states that as described in the statement of purpose, prospective service users will be introduced to the home and invited to look at its suitability and then supported with an overnight stay. The manager also added that any service user who accepted a place in the home would have a service users agreement. 49 ESSEX PARK Version 1.10 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 standard(s) 6,7,9 Information contained in the individual plans is not organised in a way that makes them easy to follow. This could impact on the care and support received by service users and delay any monitoring of progress that should be made. Essex Park must address this. Service users are encouraged to take part in the running and decision making of the home. EVIDENCE: The service users that live in Essex Park are largely unable to represent themselves. Most have communication difficulties and rely on their relationships with staff who have known them for a considerable length of time to interpret their needs on day to day issues. Some service users have relatives and one service user has an advocate and befriender who represents him. The inspector was able to examine the individual plans of three service users currently in the home. These plans, drawn up some time ago are of a good standard. These included health needs, specialists involved in their care, social needs and recreational activities including phobias, and details of any medication taken. The plans included detailed assessments by therapists with goals to be achieved. Other plans included guidelines for reducing incidents of aggression or managing challenging behaviour. The inspector found that these files were extremely disorganised and the service user plans had not been 49 ESSEX PARK Version 1.10 Page 10 reviewed for at least one year. These plans must be reviewed at least every six months. Due to the disorganisation of files the inspector believes that important information is being missed and the goals set out in these plans are not being monitored or possibly achieved. Service users do not have their own bank accounts and the system that the new manager has inherited for managing service users money is inadequate. The manager is in the process of organising bank accounts for all service users. A requirement is made in respect of this. A requirement is also made in respect of reorganising service user plans so they are easy to follow and reviews are completed at least Six monthly. The inspector and manager discussed a service user who is visually impaired. The service users bedroom is located close to the kitchen and she feels her way into this area. No risk assessment hass been completed. It is a requirement of this report. To ensure that the location of the bedroom and kitchen safety is satisfactory. 49 ESSEX PARK Version 1.10 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 standard(s) 12,13,14,15,17 Service users are encouraged by staff to participate in community activities. Service users are encouraged to develop their skills and hobbies. Service users maintain relationships with family members with assistance from staff. Family members are encouraged to be involved in the life of service users in the home. Service users participate in the planning and basic preparation of meals if they wish to do so. EVIDENCE: Essex Park service users have a wide range of activities that they participate in. Service users attend day activities in Barnet College, this focuses on increasing independent living skills. Other centres such as St Barnabas centre, and St Albans Church, all encourage the pursuit of hobbies such as music, drama,and painting. Service users use the local parks, visit galleries, go swimming, bowling, pub lunches and are supported to go to other places of interest. The home has a television, music centre and a computer. There are also board games available. The programme of activities is contained in service user files and is on the wall in the managers office. Some service users have contact with their relatives and spend time with them away from the 49 ESSEX PARK Version 1.10 Page 12 home. Others have only telephone contact. One service user who has no relatives has an advocate and a befriender. The service users birthdays are celebrated in the home and family often attend. One service users birthday was celebrated two days before the inspection and birthday cards from family and staff were on display. The inspector was able to see the variety of food available in the home. The fridge contained plenty of fresh produce for service users and the menu plans indicated a balanced and nutritious diet. These plans are pictorial to promote service users understanding. 49 ESSEX PARK Version 1.10 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 standard(s) 18,19,20,21 Service users are supported by staff whom, with the assistance of the manager have improved their practice in relation to their personal care and administration of medication. More consistency is required with the recording of service users wishes in the event of their death. EVIDENCE: Essex Park service users are supported with their personal care according to their care plan. Some service users require help with most aspects of their personal hygiene. Staff describe this as being undertaken in a respectful, sensitive way while encouraging service users to do as much as possible for themselves. Service users are supported to purchase age and weather appropriate clothes with their key workers. Service users are also gently encouraged with all aspects of their intimate personal care. The inspector saw three service users who were clean and approriately dressed. On the day of inspection one service user was attending her medication review with the support of a member of staff. There was evidence on all files inspected that the medical needs of service users are attended to by the home and community health services. The inspector saw the accident and incident book. The new log is very clear with good guidelines and an index of accident and incident forms. One accident, which required admission to hospital, was recorded. The accident incident book in the home is used appropriately. 49 ESSEX PARK Version 1.10 Page 14 The present manager in the home has ensured that most staff were recently trained in medication administration. The policy on medication is robust and clear. The manager has also introduced excellent medication care plans which detail the medication, side effects, where service users prefer to be when taking medication, and when medication reviews are due. These are also described in pictorial format. There is also a register of signatures for staff administering medication and guidelines for administering covert medication. All files have details of consultant psychiatrists, GP’s and community liaison nurses giving permission and advice on covert medication administration. The inspector looked at the medication of service users and the MAR Charts completed. These were satisfactory. The individual plans inspected did not consistently clarify the wishes of services users in the event of their death. This is a requirement of this report. 49 ESSEX PARK Version 1.10 Page 15 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 standard(s) 22,23 Essex Park have an adequate complaints policy and procedure. No complaints have been recorded in the last 12 months. The home have failed to ensure, following two previous requirements that the adult protection and whistle- blowing procedures include the contact details of the CSCI EVIDENCE: Essex Park has a complaints procedure that complies with the standard and includes details of the CSCI. An immediate requirement was issued during this inspection following the delay in Essex Park amending their adult protection and whistle blowing procedures to include the contact details of CSCI. 49 ESSEX PARK Version 1.10 Page 16 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 standard(s) 24,25,27,28,30 Essex Park has made huge improvements to the maintenance and repair of the home externally and internally. The environment is still not entirely up to the required standard. An immediate requirement was made for a service users wardrobe to be repaired. The home must continue with the upgrading programme it has outlined. EVIDENCE: Essex Park were subject to a number of requirements relating to the external and internal decoration and maintenance of the home. The requirements for the provision of non slip flooring in the bathroom and the replacement of the rusty radiator have been met. A new shower rail has been purchased, radiator covers have been replaced and new hanging curtains have been repaired. The external works to the building such as the masonry to the rear and the front of the building have been repaired as has the handrail at the front of the home, patio steps, and the exterior woodwork. The guttering at the side of the building has also been repaired. This has all made a significant difference to the appearance of the home. The manager showed the inspector a plan of repairs that has been discussed with the service manager. These repairs will be programmed for completion over a period of time. 49 ESSEX PARK Version 1.10 Page 17 The inspector was invited into two service users bedrooms. One service user was pleased to show the inspector her bedroom, which she said was recently painted and furnished to her taste. The room was very cosy and personal. The inspector noticed that the wardrobe door was no longer attached. The repair of the wardrobe was a previous requirement. An immediate requirement was issued to get this repaired. The other service users bedroom reflected her specialist needs and behaviours and was deemed appropriate. The bathrooms in the home are adequate for the service users needs and promote their privacy and independence. The inspector did a tour of the building. The lounge remains bright airy and comfortable although the manager would like to upgrade this further. The dining area, which leads to the garden has also been recently decorated and also has a computer for service users to use. However the manager has said that service users have not shown any interest in this. The garden is well tended and the manager advised that service users have access whenever they wish. Whilst efforts have been made to improve the standard within the home there were still areas for development. The home has a broken panel in the front door, which requires replacing and the skirting boards in the home require cleaning. Requirements are made in respect of this. The manager advised that she has introduced a cleaning programme for staff and the part time cleaner and this will be added to the list. 49 ESSEX PARK Version 1.10 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35,36 Staff at Essex Park now feel supported by a competent management team. Staff are receiving training and regular supervision to ensure that their responsibilities are carried out to a satisfactory standard. EVIDENCE: Following a period of instability in the home, a new manager and deputy have been seconded. This has reduced the stress on the staff team .The manager and deputy have implemented clearer procedures for working with service users whilst valuing the care given and the knowledge staff have of the service users. Systems are now being put in place to ensure that Essex Park meets its responsibilities as a provider of care to vulnerable individuals. This includes changes to the medication procedure, and increased personal care support for some service users. The manager has identified training needs for staff. Since the manager has taken up her post in January 2005, all staff have completed values in the house training. This focuses on the respect staff working in the home should have for those who reside there. The training also outlines expectations the organisation has on staff in relation to maintaining a homely atmosphere and respecting the wishes and feeling of service users who live there. Staff have also had medication training. Some staff have completed food hygiene, manual handling, diversity, and first aid training. The manager is currently in the process of organising training for staff that will assist with updating the individual plans, focusing on the methods and meaning of communication with non verbal service users. 49 ESSEX PARK Version 1.10 Page 19 The inspector was able to speak to three staff members. One staff member said “The manager is very understanding as she has been a carer before and understands the pressures of the job” another staff member added that “The managers are trying to standardize procedures and practice and this is positive”. Staff believe that their ideas are listened to and considered by the manager. Staff presented as positive when talking about training and being with service users. Staff expressed that the training enhances their ability to communicate with people who are non verbal. Staff confirmed that they receive regular training and supervision. They receive copies of the supervision records with actions. When asked, not all staff were clear about the importance of the whistle blowing policy. 49 ESSEX PARK Version 1.10 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38,40, 42,43 Essex Park have some way to go with updating its policies and procedures. This standard is not met which could comprmise the way in which service users are supported and protected. Staff must be familiar with these documents when updated. Testing of equipment in relation to health and safety is overdue and food labelling must be consistently carried out. EVIDENCE: Essex Park has had a stable management team since January 2005. The staff had been managing to the best of their ability for sometime before then. The leadership and direction of the management team has enabled staff to practice better care for the benefit of the service users. The manager and deputy are updating systems and procedures in the home and have started with those that carry the most risk. The inspector spoke to staff and not all staff were clear about the whistle-blowing policy. The inspector believes that staff should familiarise themselves with the homes policies and procedures to ensure thay are working to the correct standards particularly for the benefit of service users.The inspector was shown evidence of compliance with fire safety. An 49 ESSEX PARK Version 1.10 Page 21 assessment of fire risk and safety was completed by the Fire service on the day before the inspection. Details will be available when the report is completed although the manager stated that the fire service is satisfied that there is no cause for concern. The inspector checked the storage of food in the kitchen and found that food is not being labelled, although no food was out of date it is essential to minimise the risk of food poisoning. This is a requirement of the report. The home is not in possession of any documentation relating to the regulation of water temperatures and solutions to control the risk of Legionella. This is also a requirement of this report. The inspectopr found that food stored in the kitchen is not labelled. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 49 ESSEX PARK Score 2 2 x Standard No 24 25 26 27 28 29 30 Version 1.10 Score 2 3 x 3 3 x 2 Page 22 9 10 LIFESTYLES 1 x Score STAFFING Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 x x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x 1 3 49 ESSEX PARK Version 1.10 Page 23 Are there any outstanding requirements from the last inspection? 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 6 Regulation 14, (2), (a) Requirement Timescale for action 31/07/05 2. 6 3. 7 4. 9 5. 9 6. 21 7. 23 The registered person must ensure that service users assessed needs are kept under review. 15, (2), The registered person must (a) ensure that the service users plan is orderly and reviewed at least six monthly. 20,(1),(a) The registered person must ensure that the service users have their own bank account and any monies belonging to service users is paid into their account. 13,(4), (c) The registered person must ensure that a risk assessment is undertaken for a service user with visual impairment. In relation to her bedrooms proximity to the kitchen. 13, (4), The registered person must (C) ensure that risk assessments are undertaken on all service users to ensure their safety in the home. 12, (2) The registered person must ensure that service users and their families or representatives wishes are fully recorded in the event of illness and death. 17 (3) The registered person must ensure that the whistlblowing Version 1.10 31/07/05 31/08/05 31/07/05 31/08/05 31/07/05 24/05/05 49 ESSEX PARK Page 24 8. 24 9. 10. 30 42 11. 42 12. 42 13. 42 procedures and adult protection policies contain the contact details of the CSCI. An immediate requirement was issued at this inspection. This requirement is restated from the last inspection. Timescale 31/12/04 not met. 23 (2), The registered person must (b), (c) ensure that the wardrobe door in a service users bedroom is properly fitted. An immediate requirement was issued at this inspection. This is restated from the last inspection. Timescale 31/12/04 not met 23, (2)(d) The registered person must ensure the skirting boards are cleaned regularly. 23, (2) (c) The registered person must ensure that portable appliances are tested yearly and that these records are maintained. 13, (3), The registered manager must (4),(c) ensure that the water supply is tested and chlorinated to ensure that there any risk of legionella is detected and treated. 13, The registered person must (4),(a),(c) ensure that the broken glass panel in the front door is replaced. 16, (2), The registered person must (g) ensure that all food is labelled to ensure consumption within the specified time and minimise the risk of food poisoning. 31/05/05 31/07/05 31/08/05 31/07/05 31/07/05 3/06/05 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. 49 ESSEX PARK Version 1.10 Page 25 Refer to Standard Good Practice Recommendations 49 ESSEX PARK Version 1.10 Page 26 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA 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 49 ESSEX PARK Version 1.10 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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