Inspection on 21/06/06 for Fernwood Court

This inspection was carried out on 21st June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fernwood Court 26/02/08

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

CARE HOMES FOR OLDER PEOPLE Fernwood Court 300-310 Wolverhampton Rd West Bentley Walsall WS2 ODS Lead Inspector Mrs Amanda Hennessy Key Unannounced Inspection 21st June 2006 09:15 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 Fernwood Court DS0000066372.V289736.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. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernwood Court Address 300-310 Wolverhampton Rd West Bentley Walsall WS2 ODS 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) 01902 604200 Southern Cross Healthcare Facilities Ltd Ms Gwendolyn Sheehy Care Home 59 Category(ies) of Dementia - over 65 years of age (59) registration, with number of places Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That the staffing levels agreed by the Responsible Individual and returned to CSCI in a letter dated 6 June 2005 are not reduced without prior consultation and agreement with the CSCI. That proposals are received from Southern Cross Healthcare Facilities Limited in respect of unitising the home within four weeks of the date of registration. That the seven younger adults with mental health needs (MH) are found alternative placements within four weeks of the date of registration. That the variation granted on the 13 September 2005 for one female service user who is 57 years and has dementia will only be for the lifetime of that service user and whilst the home is able to meet her needs. That the variation granted on the 14 September 2005 will be for the lifetime of those five identified service users and whilst the home is able to meet their needs. 5/12/05 5. Date of last inspection Brief Description of the Service: Fernwood Court is a purpose built, four storey building. The home has been privately owned by Southern Cross Healthcare Services Ltd since June 2005 since which time it has changed its name to Fernwood Court. The care home can accommodate up to 59 older people with dementia requiring personal care. There are communal rooms and assisted bathrooms on each floor. A passenger lift provides access to each floor. The home has a laundry and kitchen situated on the ground floor. The home has an enclosed garden at the rear of the building and a large car park at the side. All service users’ bedrooms have en-suite facilities. Fees vary between £349.45 and £425 and are dependant on the needs of the service user and the type of room that will be occupied. There is an additional charge for chiropody and hairdressing which are not included in the homes fee. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Mrs Amanda Hennessy and Mrs Mandy Beck. The inspection was carried out between 09.15 and 17.30. The inspection included a tour of the building, talking to service users, staff and visitors and a review of records. Service users completed questionnaires that asked their views on the home, and positively identified their life at the home. A review of information supplied by the Manager (pre inspection questionnaire) was also undertaken and expanded upon during the visit. Care records were reviewed as part of the “case tracking” of five service users. The homes ownership changed in June 2005 with the home now owned by Southern Cross Healthcare Ltd and since which time has changed its name from Churchill Court to Fernwood Court. This is the first inspection of the home as Fernwood Court. Eight of the thirteen previous requirements were found to have been fully addressed. Three further requirements were made following the inspection. What the service does well: What has improved since the last inspection? The Manager has continued to develop the home improving the environment to meet the needs of service users with dementia. Staff training and development has increased and has included the successful appointment of one of the exiting staff members as Deputy Manager. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fernwood Court DS0000066372.V289736.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 Fernwood Court DS0000066372.V289736.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 The overall outcome for this group of standards is judged to be good. Service users can be assured that their needs will be assessed prior to their admission to the home and that the staff are equipped with the necessary skills to meet those needs. EVIDENCE: The manager or senior staff from the home visit prospective new service users at their home or in their current situation to undertake an assessment of their needs prior to admission. This means that the manager and the service user are able to make a decision about whether the home can meet their needs. It was also pleasing to see when examining service user files that copies of recent social work and nursing assessments had also been obtained and were being used alongside the home’s own documentation to provide an overall picture of service users needs. All new service users are encouraged to have a trial visit at the home to make sure that they are comfortable with it and they feel that their needs will be met there. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 9 The staff are currently undertaking training in dementia care and “behaviour that challenges” this will equip them with the skills and knowledge they will need to care for people with dementia and begin to develop a more person centred approach to the care they provide. Fernwood Court DS0000066372.V289736.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The overall outcome for this group of standards is judged to be adequate. Each service user has a service user plan that details their needs, generally all health needs are being met. Medicine is not stored at a safe temperature to ensure its effectiveness and the safety of service users. Service users can be assured that they will be treated with respect and dignity at all times. EVIDENCE: Each of the service users files seen contained care plans that detailed what needs each service user had. One relative said that:“ We have been impressed by the thorough way in which our mother has been assessed and appropriate provision for her medical care and welfare has quickly and effectively been put into place.” Generally the plans are reviewed on at least a monthly basis by care staff and this is documented in the service user plan. The manager must explore ways to involve the service user in this process in order to demonstrate their understanding of the care being planned for them and to show their agreement with it. There were risk assessments in place that assessed the potential development of pressure sores, the risk of falling, moving and handling risks to Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 11 both staff and service user and nutritional needs. The home must ensure that the information for each service user is consistent throughout their plan. For example one service user was assessed as not being at risk of malnutrition and had a good appetite on the pressure sore risk assessment but on the nutritional risk assessment it was documented that the service user was underweight and needed dietary supplements to manage her needs. Staff have made very good progress in the way that they write care plans and complete documentation since the last inspection, although there are still things that need to be done in order to fine tune their care planning processes. It was evident that service users are assessed by a range of specialist nurses and medical staff and that appropriate advice, treatment and equipment is provided for them. It was reported by the manager that the home has considerable difficulty trying to arrange for GP services when service users are new to the home and that this usually has to be done via Walsall Primary Care Trust. One visitor spoken to said:- “ I was impressed by the prompt and appropriate actions of the staff when my mother was taken ill”. All medicines are administered by care staff who have received additional and accredited training in the safe administration of medicines and their actions. Medication practices within the home have improved since the last inspection. There is a need for the manager to ensure that the treatment room temperature and the drugs fridge temperatures are maintained within required temperatures to ensure that medicines are safe and effective for service users. Generally all medications are being administered safely, it was noted that one service user who is prescribed Temazepam had not received it one night but the care staff had signed to say that had administered it. The tablet was still in the blister pack. Service users and staff were observed throughout the day and it was pleasing to see the positive relationship between them. Staff addressed service users according to their preference and were seen to discreetly maintain service users dignity and privacy at all times. The home has provision for all service users to be able to receive their mail unopened and for the use of a telephone if required. Staff were also able to confirm that when GP’s or district nurses visit they see service users in the privacy of their own rooms. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The overall outcome for this group of standards is judged to be adequate. Activities are available for service users but could be improved to meet all service users needs. The home encourages families and friends to visit as often as service users would like. Service users are encouraged to make decisions about the way they live their lives. Meals are appealing and provided in sufficient quantity to meet service users needs. EVIDENCE: The home does have some activities for service users to join in with. On the day of the inspection service users were enjoying music sing-alongs, having their nails painted, whilst others had gone out to the shops to buy food to make curry with. Relatives spoken to commented “it’s very hard for the staff because not everyone can join in because to the dementia”, “they play skittles some times they really enjoy that”. Each service user has an individual care plan that addresses their social needs, their likes and dislikes, this information needs to be collated by the manager and activities planned around individual preferences to ensure that there is an activity for everyone. The home is currently in the process of recruiting an activity coordinator this will help with activity provision. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 13 Relatives confirmed that “we come as often as we can it doesn’t matter what time, they always welcome you”. “ All staff make us welcome and try hard to ensure that all needs are met”. Service users are encouraged to bring their own furniture with them when they enter the home this helps personalise their rooms and helps them to settle into life at Fernwood Court. The four-week menu provides a balanced and nutritious diet and is well received by the residents. There is always a choice available with a cooked option at each of the three main meals a day. Visitors can also have a meal when the visit with service users and visitors that the food is very tasty. Mealtimes on the day of the inspection were observed to be rushed and a little disjointed as service users from two floor converge on the ground floor for their meals. Service users also had to wait for their meal with some losing concentration whilst they waited and then wandering off, necessitating that staff had to then bring them back to the tables which then caused further problem and delay. Lunch was roast pork and stuffing or steak and kidney pie with a choice of seasonal vegetables and mashed potato. Tea was fish fingers and baked beans on toast. Snacks are available throughout the day is required and there are bowls of fruit in the day rooms for service users to be able to help themselves. One service user enjoys cooking for the others and they regularly enjoy homemade curries. Service users comments about the food included: “ The meals are always very good ”. Staff give residents discreet assistance to feed themselves whenever it is required. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The overall outcome for this group of standards is judged to be good. Service users can be assured that their complaints will be listened to and acted upon. Service uses are protected from abuse. EVIDENCE: The home has received no complaints since the last inspection, the home’s policy is available to all service users and their families and informs them of the action to take should they wish to make a complaint. Most of the staff have received some training in adult protection awareness, the home’s policies and procedures are generally satisfactory but require some fine tuning so that staff are informed of the necessary action they must take if they suspect abuse. The manager has dealt with two adult protection issues since the last inspection and has worked collaboratively and appropriately with all of the agencies involved to ensure that service users are protected at all times. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The overall outcome for this group of standards is judged to be good. The home is well maintained, pleasantly decorated, clean and is a nice comfortable and safe place to live. EVIDENCE: The home is well maintained, pleasantly decorated, homely and clean. Since the change in ownership the home, changes have been made to assist people with dementia as advised by a Dementia care specialist and so it more fully meets the needs of people with dementia. Adaptations and changes include painting and putting large numbers, letter boxes and numbers on their bedroom doors, appropriate signage to aid the orientation of residents and also the creative use of colour. Sensory boards have been put up in corridor that aid memory recall of everyday items as well as having different textures for residents to touch and feel. There is good access throughout the building where residents are accommodated, with a range of aids and adaptations available for dependent people. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 16 The home has appropriate infection control procedures to minimise the risk of cross infection. The laundry is well equipped with washers that meet the requirements for sluicing and disinfection of linen. It is recommended that information is available in the laundry that identifies what programme laundry is washed at to ensure that communal items such as sheets and towels are washed at safe temperatures required by infection control guidance. Sluice disinfectors are available throughout the home for cleansing of toileting items such as bedpans and urinals. Staff hand wash facilities have controlled hot water that promotes good hand washing practice. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The overall outcome for this group of standards is judged to be good. The home has sufficient and well qualified staff to meet all service users needs. Recruitment and selection procedures are robust and safeguard the service users. Staff training opportunities are good. EVIDENCE: Staffing levels are for 50 residents are: 8am-2pm 8 Care Staff 2pm-8pm 8 Care staff 9pm-7am 5 Care Staff. Additional kitchen, laundry and domestic staff are also available seven days a week. The home currently has 24 of its 43 care staff (56 ) with a minimum of National Vocational level 2 qualification (NVQ) or equivalent. This exceeds the requirement of at least 50 of care staff with NVQ 2 an additional 9 care staff care staff are currently working towards their NVQ level 2. The home has recruitment and selection procedures that are robust and protect service users. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 18 The home has induction training for all new staff that meets National Training Organisation standards. Staff are supported to undertake further training with training needs identified as part of their supervision. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 The overall outcome for this group of standards is judged to be good. The home is effectively managed and is run in the best interests of the service users whilst also ensuring that they are protected. EVIDENCE: Gwen Sheehy has been Home Manager of Fernwood Court since September 2005. Ms Sheehy has worked in residential care homes for over twenty years and has approximately ten years experience as a manager of care homes for elderly with dementia. She has NVQ 3 and 4 in care and NVQ level 4 in Management and undertakes regular mandatory and updating training. The Home Manager is supported by a Deputy Manager and also receives support from Southern Cross Senior Managers. Ms Sheehy is well respected by her staff, peers and service users with an open, positive and inclusive management approach. Staff are encouraged and Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 20 supported to develop which is encouraging innovation and creativity within the home. Southern Cross homes have an identified Quality plan for the home. Quality audits are undertaken six monthly with corrective actions identified, with a copy of the audit sent to both the Regional Manager and Regional Director. The home undertake monthly audits of pressure sores, service users weights, accident statistics, vacancies and recruitment, the kitchen and a review of all regulation 37 notifications that have been sent to the Commission for Social Care Inspection (CSCI). Service user surveys are undertaken at least annually with identified plans of action identified. Required visits on behalf of the registered company are undertaken. The Manager and registered company proactively identify ways that requirements of Commission for Social Care Inspection will be met. Secure facilities are available for the safe keeping of service users personal money and valuables. Written records are available for all transactions which detail the reason for the withdrawal and two signatures, receipts are available as proof of purchases. Money that was randomly checked in the safe was found to be correct and equal the balance identified. Regular external audits of service users personal money is undertaken. The home has good employment policies in relation to induction of new staff. Supervision has commenced for all care staff but the Manager needs to ensure that all staff receive supervision at the required frequency. Procedures to protect service users include regular and required checks on the fire alarm, emergency lighting, fire extinguishers, nurse call points and hot water. Records identify that staff regularly attend mandatory training in fire safety, moving and handling, food hygiene, first aid, health and safety, infection control and protection of vulnerable adults. The Manager has an overview matrix of staff training to enable her to easily identify staff that need updates in required training. Maintenance records and contracts were reviewed and were found to be up to date. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 21 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 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 x x x x x x 2 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 3 3 x 3 2 x 2 Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care planning must be reviewed at least monthly alongside the service user or their nominated representative whenever possible. (previous timescale of 31/01/06 not met- there is no evidence that service users or their representatives are involved in the planning and review of their care) The registered manager must ensure that all assessed needs have an appropriate care plan to demonstrate how those needs will be met. The registered manager must ensure that all information on risk assessments is consistent for each service user. The drugs fridge temperature must be maintained between 2 and 8°c. Previous timescale of 06/12/05 not met The treatment room temperature must be maintained at no more than 25oC. A review must be undertaken of meal times and when and how DS0000066372.V289736.R01.S.doc Timescale for action 31/07/06 2 OP7 15 31/07/06 3 OP8 15 31/07/06 4 OP9 13(2) 30/06/06 5 6 OP9 13(2) 16(2)(i) 30/06/06 31/07/06 OP15 Fernwood Court Version 5.2 Page 23 7 OP30 18 8 OP38 18(1), 13(4), 13(5), 13(6), 23(4) they are served. Staff must receive training specific to their roles and the needs of the service users. This would include:· Care of service users with dementia· Awareness of mental illness· Management of Violence and aggression including deescalation techniques. Partially met. The majority of staff have received all required training. Training is being arranged for staff who did not attend original training. All staff must undertake required mandatory training: health and safety training· food hygiene training· moving and handling training· fire safety training· Protection of Vulnerable adults awareness· infection control· first aid Partially met. The majority of staff have received all required training. Training is being arranged for staff who did not attend original training. 30/09/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP26 Good Practice Recommendations Information is available within the laundry that identifies what programme laundry is washed at to ensure that communal items such as sheets and towels are washed at safe temperatures required by infection control guidance. Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Fernwood Court DS0000066372.V289736.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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