Inspection on 21/05/08 for Evendine House

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Excellent service.

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

Evendine House 22/02/07

Evendine House 20/12/05

Evendine House 31/08/05

Evendine House 01/12/04

Evendine House 17/06/04

Evendine House 28/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Evendine House Evendine Lane Colwall Malvern Worcestershire WR13 6DT Lead Inspector Wendy Barrett Unannounced Inspection 21st May 2008 09:30 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 Evendine House DS0000024707.V364889.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. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Evendine House Address Evendine Lane Colwall Malvern Worcestershire WR13 6DT 01684 540225 F/P 01684 541963 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) S B Residential Care Limited Anna Catherine Chapman Care Home 20 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (20), Physical disability over 65 years of age (2) Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2007 Brief Description of the Service: Evendine is located on the edge of Colwall, a village located in a rural area between Malvern and Ledbury. The home is set in well maintained gardens that are easily accessible to the residents. There are extensive views of the Malvern Hills and surrounding countryside. There are 20 registered places. All these places are registered for people over 65 years of age who have care needs arising from the usual ageing process. 6 of the places may be used for people over 65 years of age who have care needs arising from a mental disorder. A further 6 of the 20 places may be used to accommodate people over 65 years of age who have care needs arising from dementia. The accommodation is on two floors with access by a chair lift to the first floor. There are 19 bedrooms, one of which is for 2 people who wish to live together. All potential or new residents receive an information pack that describes the service they can expect to receive. Brochures are also displayed in the main entrance hall at the home. In January 2007 the fees ranged from £420 per week to £450 per week. There are additional charges for hairdressing, chiropody, transport, newspapers and magazines and toiletries. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. What the service does well: What has improved since the last inspection? Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 6 The premises have been further improved with the addition of a new laundry facility. All bedrooms now have an en-suite facility. There has been ongoing refurbishment and redecoration to maintain the high quality of environment. Medication management procedures have been further strengthened. There has been more attention to making sure the care is planned and provided to suit each resident’s needs and preferences. Part of this work has involved developing the existing ways used to consult residents and their relatives about the service they want. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home recognises the importance of appropriate admissions and encourages prospective residents to find out as much as they can to help them decide if the home will suit them. The staff make sure they have comprehensive information about the individual’s needs and expectations before they agree to admit. This helps them to decide if the potential admission is likely to be a success for everyone. EVIDENCE: .A resident survey form described how they got information about the home to help them decide if they wanted to be admitted – ‘Very informative literature and via face to face meetings’ . Before the home agrees to admit a new resident one of the managers visits the potential resident and finds out exactly what care they need and how they Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 9 want to live. There are records of this work and these reflect thorough attention e.g. possible risk areas are assessed. An initial care plan is then written, based on the findings of the assessment. This tells the staff how to go about their work with the new resident. Records at the home describe how prospective residents and their relatives are given information by staff at the home about alternative future care options. These include services such as extra care packages, close care or sheltered accommodation. This is very good practice because it means people really can make informed choices about their future care and need not feel that admission into a care home is their only choice. The cook explained that dietary needs are discussed before admission so that she knows in advance about any special diets etc. The cook, or one of the care staff, also has a chat with new arrivals so they can get more information e.g. what time the new resident likes to eat their meals, where they would like to eat their meals, and what particular food and drink they like or dislike. Residents described a gradual introduction to the home with plenty of opportunity to see the accommodation and experience everyday life at the home-‘ I spent a month at the home before making a decision and knew I would be contracted to be there permanently’. Mrs. Bate plans to give prospective residents even more opportunity to ‘try out’ the home before having to decide if they want to be admitted. This would also give the staff more chance to get to know the individual. The home doesn’t accept emergency admissions. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to maintain their independence but, when they need help, the staff provide this in a way that suits the individual and keeps them safe. Any change in a resident’s wellbeing is quickly identified so that additional support can be sought. Written records of this work are very well kept. Some staff may benefit from an update on their medication training, and some may appreciate more training opportunities in the common health care conditions found in the resident group. EVIDENCE: People who use the service are very happy with the way the staff look after them. All the comments made in the survey forms were complimentary e.g. ‘when necessary, help is always there’. The staff also agreed that they have the information they need to look after the residents well-‘individual needs are Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 11 regularly discussed during reviews and placements’. Two care assistants were able to demonstrate their in-depth knowledge of each resident. They knew what things were important to meet care needs but also to make the resident’s days enjoyable. One resident enjoyed buying clothes. She did this through magazines because she was rather nervous of going out to the shops. ‘Routine’ is very important to the resident so it’s important for staff to try and be prompt and consistent. The staff try hard to make sure people can continue living in their preferred way. A cohabiting couple had a very comfortable bedroom with many of their personal effects, including a double bed, in the room. The staff explained that the couple enjoyed a relaxed start to their day and there was no pressure for them to get up until they were ready. A ‘care monitoring sheet’ described how the couple’s dissatisfaction with some of the food was addressed soon after their admission. Alternatives had been offered. A visiting G.P. considers the care ‘excellent in all respects’ . Mrs. Bate is always looking for ways to check that each resident is happy with the service. She has plans to implement quarterly review and feedback meetings to strengthen the current methods of consulting residents. The records at Evendine are very well written and are constantly updated. They are prepared on a computer so that they can easily be altered when there is any change in the resident’s situation. The written records show how the care is planned to suit the individual, and how staff check to make sure it is always satisfying the residents. A trial period Care Review report gave details of a discussion with a new resident and her representative (her accountant). Mrs. Bate had signed the report but the resident didn’t sign it although there is a place for this on the form. It would be better to make sure the resident or their representative signs these records so it is clear they were involved in writing it. Medication is managed safely at the home. There were recommendations arising from the last inspection to strengthen the practice and Mrs. Bate and the staff have made improvements. When residents want to manage their own medication the staff complete a risk assessment to make sure it will be safe. One of these assessment reports was seen at the home. It was being reviewed quarterly or more often if needed. The resident had signed it in April 2008 to confirm their agreement with it. Two new medicine trolleys have been bought so that there is a secure way of storing and carrying around medication on each floor of the home. Boots pharmacy has been consulted with the result that ordering and delivery arrangements have been improved. The staff have received appropriate training in handling medication although this was provided some time ago and may need updating now. A care assistant last received training in dementia care in 2006. She said she would welcome more training opportunities in common health care conditions e.g. diabetes. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 12 Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to continue living in the way they prefer, and their relatives are actively encouraged to stay involved. Meals are planned and provided in a way that takes very good account of individual dietary needs and preferences. EVIDENCE: Residents have the opportunity to participate in regular social events inside and outside of the home e.g. local garden centre visits, pub visits, live musical entertainments, exercise sessions and religious worship. They are able to choose how they spend each day-‘I enjoy cross stitch and reading and activities sessions’, ‘I choose to spend more time in my room. I keep mentally active’. Relatives feel welcomed into the home –‘I have good access to the home and have good relations with the owners and staff’. The staff have recognised that there needs to be more attention to supporting people who use the service and have sight or hearing difficulties. There are plans to liaise with the Association for the Blind for guidance with this. It is Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 14 recognised that there needs to be more time for one to one social activity and the staff are keen to develop this part of their work-‘spend more time with residents’-‘take them out for a walk’. Work routines are already being altered to accommodate this. This will be appreciated because a few residents would sometimes like alternative types of activity that would suit them better. The catering staff know what each resident likes to eat, and if they are on any special diet. The staff try hard to satisfy each resident e.g. a resident was reluctant to eat with other residents. Staff discovered she was embarrassed about messy eating. A plate guard has solved the problem and she now enjoys eating with other residents. There are some very complimentary comments about the quality of the catering service-‘the cook knows what I like’, ‘meals are very good’. A resident also mentioned the introduction of some new menus. The records of food provided show a considerable number of alternative choices being served. The cook completes feedback forms so that the Providers know what the residents think of the menu and can alter future menus if need be. She demonstrated a thorough awareness of the type of foods she needed to prepare for residents on special diets. The local G.P. and district nurses are apparently very helpful in offering guidance with any special diets that the cook is asked to provide. All the catering staff hold up to date food hygiene certificates. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know how to raise complaints and concerns, and when they do, these are carefully looked into. Staff understand how to protect residents from abuse and relatives feel confident that the staff will keep the residents safe while supporting them to continue living in the way they prefer. EVIDENCE: A complaints procedure is included in the residents’ information pack and is also displayed at the home. This makes it clear how to raise concerns about the service. Residents’ survey responses confirm that they understand how to raise any concerns. The Commission hasn’t received any complaints about the service, but the home keeps a record of any minor concerns raised and the action they have taken to respond to these. This record shows an open, balanced approach. The care records show how residents are encouraged to control their own lives but are also protected through regular monitoring of any potential risks. The introduction of a more comprehensive induction training for new staff has widened attention to the protection of vulnerable adults although two more long standing staff weren’t familiar with protection procedures and may need further training in current protocols. Mrs. Bate plans to revise the internal adult Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 16 protection policies and procedures so they reflect new legislation under The Safeguarding Vulnerable Groups Act 2006. This may be a good time to refresh staff awareness. The people who use the service say they would feel able to speak to the manager or the carers if they were worried about anything. The staff showed good awareness of the need to pass on any resident concerns to senior staff straight away. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a very attractive home that is maintained to ensure their safety and comfort. EVIDENCE: The residents’ accommodation is very well presented to a high standard. All areas were clean, warm and bright at the time of the inspection visit. There has been ongoing work to further improve the premises and maintain the high standards. All bedrooms now have en-suite facilities. A new laundry has been introduced. It is equipped with a new industrial washing machine with sluice facility and a new tumble drier. The staff have colour coded laundry bins and separate cleaning materials for use with residents who have sensitive skins. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 18 The kitchen and dishwashing area has been completely overhauled. Other areas have been re-decorated and re-carpeted. Safety and hygiene is well managed. Staff have the written guidance and equipment they need to help them with infection control e.g. relevant policies and procedures, liquid soaps and paper hand towels. 23 staff have completed infection control training. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the residents’ needs because the levels are altered to reflect any change in circumstance at the home. New staff are carefully checked before being employed to be sure they will be safe to work with vulnerable adults. New staff are well supported when they start work at the home. This makes sure they work safely with the residents. The importance of regular training opportunities is recognised and subject to ongoing attention. EVIDENCE: There were enough staff on duty at the time of the unannounced inspection to meet the residents’ needs. Mr. Bate was present in the premises and the care manager and deputy manager were also at work. Care staff were being supported by catering and cleaning staff. The cook said that she would be allowed to work a few extra hours if she felt there was a need. This is reassuring because it’s important that staffing levels respond to any changes at the home. Previous evidence has shown that new staff are subject to the necessary checks of their suitability to work with vulnerable adults. This satisfactory situation was reflected at the current inspection. There are robust procedures Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 20 to make sure new staff are suitable and safe to work with the residents. A staff member commented that ‘they made sure that I had all the valid and proper documents before I started work’. Another staff member said that ‘I knew what was expected of me-all relevant training was covered’. Visiting care professionals have confidence in the way staff are supervised. One commented ‘it would seem during reviews (meetings) that staff are appropriately supported and managed’. The initial induction training of new staff has been strengthened and Mrs. Bate has plans to review individual staff training needs more regularly. She also has plans to help staff develop their skills in providing care in a way that reflects the individuality of each resident. This is called ‘person centred care’ and is the best approach to make sure each resident feels comfortable with his or her life at the home. Well over half the staff involved in care have either achieved a national vocational qualification (NVQ) in care or were working towards this. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the residents and their views are taken into account when future plans are developed. The management is very well organised to be sure that residents’ interests are protected at all times. EVIDENCE: There has been consistent confidence in the way Evendine is managed and this continued to be reflected in the comments arising from this inspection consultation exercise- ‘Overall the standard of care is high and the support is good’,. ‘The location is very good from the aesthetic point of view and the grounds are pleasant’, ‘the home has developed a good local reputation and always has a waiting list ’, ‘In my Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 22 experience all aspects of the care home are undertaken with great care and understanding’ . Both Providers and the Care Manager have a recognised qualification and all have considerable relevant experience. Each manager has a clear job description so that all aspects of the service receive thorough attention. The Providers work regularly in the home and this gives the Care Manager time to work out in the home supervising the care given by junior staff. The annual quality assurance assessment report that was submitted to the Commission contained a lot of relevant information about the way Mr. And Mrs. Bate manage the service. They regularly consult the people who use the service so they know what things are important to the residents e.g. the AQAA report refers to plans to introduce feedback forms after initial periods of residence. Computerised records support the administrative functions and a sample of inspected examples confirmed that the records were being kept up to date. Arrangements for insuring and safeguarding residents money and valuables are satisfactory. There is a programme of staff individual supervision and appraisal. Staff survey forms refer to managers who always have time to discuss the work with individual staff, and a regular programme of supervision and appraisal to monitor staff performance. A new staff member commented ‘I have only worked at Evendine House for one month but I have had feedback on my progress’. One of the Providers takes the lead with health and safety arrangements. Mr. Bate attends relevant training courses to be sure he is aware of any changing legislation e.g. fire safety management. He was able to confirm that routine gas and heating services had been arranged for June this year. A certificate dated December 2007 confirmed portable appliance electrical checks had been completed. Mr. Bate agreed to consult his electrician to review whether electrical circuit testing should be arranged because this check hadn’t been done since April 2002. Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 23 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 x x 4 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 x x 3 Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations Some staff may benefit from refreshers of previous training provided e.g. medication, adult protection. It may also be useful to consider more training in common health care conditions e.g. diabetes, dementia care. Evidence of consultation would be strengthened if residents or their representative were routinely asked to sign care planning records when they have participated in this work. 2. OP7 Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Evendine House DS0000024707.V364889.R01.S.doc Version 5.2 Page 26 - 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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