Inspection on 06/03/07 for Franklyn Lodge

This inspection was carried out on 6th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Franklyn Lodge 27/10/05

Franklyn Lodge 22/02/05

Franklyn Lodge 27/04/04

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

CARE HOME ADULTS 18-65 Franklyn Lodge 58 Kings Road Franklyn Lodge 58 Kings Road London NW10 2BN Lead Inspector Jane Ray Key Unannounced Inspection 6th March 2007 1:30 DS0000017458.V325279.R01.S.doc Version 5.2 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 DS0000017458.V325279.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 Adults 18-65. 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. DS0000017458.V325279.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Franklyn Lodge 58 Kings Road Address Franklyn Lodge 58 Kings Road London NW10 2BN 020 8830 0142 020 8903 9860 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) Residential Care Services Ltd Dr Lynda Osarieme Eribo Care Home 4 Category(ies) of Learning disability (4) registration, with number of places DS0000017458.V325279.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27th October 2005 Brief Description of the Service: 58 Kings Road is registered to provide a service for up to four younger adults with a learning disability. At the time of this inspection, there were three service users living at the home. The home is operated by Residential Care Services Ltd and is one of seven care homes in the group. The home has a registered manager. The home is a terraced property located in Willesden Green, Northwest London. It is close to a range of health and social care facilities plus a variety of shops, public transportation services, leisure, social and religious amenities and services. The home has a compliment of 7 care staff, including bank staff with a range of skills and experience in social care. Two staff are normally on each duty shift and one staff sleeps in as part of the night staffing cover. During the middle of the day from 10am to 3pm the home may be un-staffed. Additional support and professional input is also received from health and social care professionals who are located in the surrounding community. The current fees in the service range from £885 - £1474 per week. The provider must make information available about the service, including inspection reports to service users and other stakeholders. DS0000017458.V325279.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 6 March 2007 and was unannounced. The inspection took three and a half hours to complete. The inspector was able to spend time with all the service users when they returned from their day activities. The inspector was also able to speak to the two care staff who were on duty. The deputy manager assisted the inspector. The inspector did a full tour of the premises and also looked at all the relevant records including service user records, staff files and health and safety information. The inspection is the annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Younger Adults. The inspector also assessed the progress made by the service in meeting the recommendations from the previous inspection. The inspector would like to thank the service users and staff for their assistance with the inspection process. What the service does well: The home provides a high standard of care and support to a group of service users with a range of complex needs. Two of the service users were able to tell the inspector how much they enjoy living in the home and how much they value their friendships with each other and their positive relationships with the staff. The home meets the service users cultural and religious needs and supports them to attend a place of worship when they wish to do so. The home by working consistently and professionally with the service users in partnership with other care professionals is able to support the service users to make progress with their personal development. The staff demonstrated a good knowledge of the service users and were able to recognise their individual needs and how to respond appropriately to them. The service users are supported to have their individual needs met by a comprehensive care planning system, which incorporates ongoing review meetings. The service users are supported to develop their independent living skills in the home and community, based on their individual needs. DS0000017458.V325279.R01.S.doc Version 5.2 Page 6 The service users are supported to access a range of structured and leisure activities based on their individual interests and this enables them to have participation in the local community. The service users all feel able to express their views on the running of the home and their daily lives. A team of staff that are effectively managed support the service users. The staff have access to a comprehensive induction and an ongoing programme of training to enable them to perform their roles to a high standard. The staff show a high level of enthusiasm and commitment to their work in the home. The home is very clean, comfortable and homely and the service users each have an attractive single bedroom. The service users are protected and supported by the effective use of policies and procedures including medication systems, adult protection procedures, comprehensive risk assessments, health and safety procedures and an effective complaints procedure. What has improved since the last inspection? What they could do better: DS0000017458.V325279.R01.S.doc Version 5.2 Page 7 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. DS0000017458.V325279.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection DS0000017458.V325279.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users have been supported to have comprehensive assessments. Service users can be assured their individual needs will be met by the home. EVIDENCE: The inspector looked at the three service user case notes. They have assessments provided by the care manager from the placing authority and also assessments prepared by the home. This information provides an overview of each service users individual needs. The inspector observed that the staff were supporting the service users in an appropriate manner that reflected their knowledge and understanding of their individual needs. The service users were also observed to be comfortable and relaxed within their home environment. Two of the service users told the inspector how they were very happy in the home and felt well supported by the staff team. DS0000017458.V325279.R01.S.doc Version 5.2 Page 10 The service users all moved to the home a number of years ago. The deputy manager explained the admissions procedure and this includes opportunities for potential service users to spend time visiting the home. The service users all have a completed contract between themselves and the home that is available in a user-friendly format. DS0000017458.V325279.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Service users are each supported to have comprehensive individual care plans and risk assessments and are working towards clearly defined goals agreed in partnership with families and other care professionals. Service users are supported to make decisions about their daily lives within the home and service user meetings take place regularly. EVIDENCE: Three service user case notes were inspected. Each service user has individual care plans, which are available in a user friendly format. These reflect the decisions made at each service users review meeting where they are supported to make decisions about their personal goals. These meetings take place with the care manager approximately once a year and there is also a review meeting arranged by the home on a six monthly basis. These review meetings were clearly recorded and demonstrated multi-disciplinary working. The goals DS0000017458.V325279.R01.S.doc Version 5.2 Page 12 agreed at the review meeting such as to develop some more independent living skills had been incorporated into the service users care plan. The care plan goals are clear and easy to understand and are monitored on a monthly basis. These goals focus on supporting the service users to gain greater independence and to look at how their lives can be further enhanced by improved activities or by addressing healthcare or emotional issues. The three service users all had a named key worker and a member of staff was able to describe how this role is implemented. One of the service users had been able to sign his care plan. The three service users whose case notes were inspected all had complex behaviours and guidelines had been prepared as part of the individual risk assessments to enable the staff to identify when the service user is distressed and what action they should take in response to this situation. These guidelines were clear and could be followed by the staff team. The staff were observed supporting the service users and the inspector could see that the guidelines were appropriately implemented. The three service user case notes inspected all included comprehensive individual risk assessments covering all areas of potential risk and this identified what action the home would take in response to the identified risks whilst at the same time promoting each service users independence. These covered a number of areas including accessing the community. Throughout the inspection the service uses were observed being consulted about decisions concerning their daily lives. This included being asked what they wanted to drink and what they wanted to do in the evening. The record of the service user meetings was inspected. These took place on a regular monthly basis and discussed activities, food and things that were happening in the home. DS0000017458.V325279.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service users are supported to have full and active lifestyles. They also enjoy contact with their relatives and friends. The service users are offered a wholesome and healthy diet. EVIDENCE: The service users and staff explained that the service users access a range of activities based on their individual needs and interests. Two service users were observed returning from a full-time structured day service. The other service user has an individual 1:1 day service and told the inspector how he had enjoyed a session at the gym followed by a sauna on the day of the inspection. The service users are supported to enjoy a number of leisure activities including going to the pub, Gateway club, and day trips. They also participate in activities within the home, including reading the paper, playing board DS0000017458.V325279.R01.S.doc Version 5.2 Page 14 games, music and watching football. One service user showed the inspector his drum kit. The deputy manager explained that the service users had been on a holiday at Butlins and one service user said this had been lots of fun. The manager explained that all of the service users have contact with their families or friends. They are made welcome in the home or service users are supported to go to their family homes. The service users were able to tell the inspector about how they enjoy seeing their relatives and also have friends from other homes. It was observed that there was a friendly atmosphere in the home with the staff chatting to the service users. The service users were observed to be very relaxed with the staff and were keen to tell them about their activities that had taken place. From discussions with staff it was described that service users were being supported to follow their own routine with one service user choosing to get up and have a long trip at the weekend and another service user preferring to rest at home. The menu for the week and the record of food consumed was inspected and this offered a healthy diet. The deputy manager explained that the service users help choose the food. The inspector did however note that the home uses tinned food on a very regular basis and in the last week had offered tuna, pilchard and corned beef on five occasions. It is recommended that the home reduces the use of tinned and frozen food and provides more fresh produce. DS0000017458.V325279.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Service users are supported to receive personal care according to their individual needs and wishes. Service users are supported to access healthcare services based on their individual needs. Service users have their safety maintained by appropriate medication administration procedures. EVIDENCE: It was observed during the inspection that the service users were given support with their personal care based on their individual needs. Some just need prompting whilst others need individual support. The service users were all very well dressed and groomed. One service user told the inspector how he does to the local hairdressers to have his hair cut. The healthcare records were inspected for three service users. They had all been supported to access the GP, dentist and optician. In addition service users attend outpatient appointments for their specialist healthcare needs including psychiatry and urology. All healthcare appointments are appropriately recorded and include the outcomes of the appointments. The service users are also supported to have their weight checked on a fortnightly basis. DS0000017458.V325279.R01.S.doc Version 5.2 Page 16 The medication systems in the home were inspected. The home uses a dossette box system. The medication was appropriately stored. The medication administration records were completed correctly for all medication including creams. The medication entering and leaving the home is recorded appropriately on the medication administration record and a separate book. The staff training records were inspected and all the staff who administer medication had an appropriate training certificate to confirm medication training had taken place although it is recommended for two staff who had the training in 2002 that this training is updated. DS0000017458.V325279.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users can be confident that any complaints they may wish to make will be appropriately addressed. Service users are protected by adult protection procedures and their money is safeguarded by the use of financial procedures and records. EVIDENCE: The inspector looked at the complaints record and could see that the home had received no complaints since the previous inspection. The inspector looked at the complaints procedure and this is a comprehensive document. The staff training records were inspected for three members of the staff team. These indicated two of the staff had received training on the protection of vulnerable adults although this had taken place in 2003 and the other member of staff had not yet received training. The staff training records also showed that all of the staff whose records were inspected had received training on how to work positively with service users who have complex challenging behaviours although for two staff this had taken place in 2003. The deputy manager explained that two service users have relatives as their appointees and the other service user has the placing authority performing this role. The finance records and cash were inspected for two service users. One service user just has cash available in the home and there are records of DS0000017458.V325279.R01.S.doc Version 5.2 Page 18 expenditure and receipts available. The other service user has a building society account and the inspector could see that when cash is withdrawn from this account this is entered in the cash record in the home. This allowed the home to have evidence of an audit trail for their money. This service user has not been receiving his DSS benefits but there was a record that the placing authority was addressing this matter. DS0000017458.V325279.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service users live in a homely, comfortable and safe environment. EVIDENCE: The inspector did a tour of the home and looked at the bedrooms. The home was clean and tidy throughout. There are four bedrooms, one on the ground floor and three on the first floor. Each service users bedroom was well furnished and was homely and personalized. The communal space consists of a large lounge and dining area and a small kitchen. These were also well furnished and comfortable. There are adequate bathing facilities with a shower room on the ground floor and a bathroom and DS0000017458.V325279.R01.S.doc Version 5.2 Page 20 separate toilet on the first floor. The home has a small laundry on the ground floor. All the equipment in the home was observed to be in good working order. The home has a pleasant rear garden with patio area and this was observed to be well maintained. The home has an office located in a loft extension. The deputy manager explained that this is used for staff training and review meetings. DS0000017458.V325279.R01.S.doc Version 5.2 Page 21 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are supported by a core team of permanent and experienced staff, but staff vacancies need to be filled to provide consistently high standards of care. EVIDENCE: The inspector looked at the staff rota. The staff team consists of a manager, deputy manager and a team of carers. The permanent staff have been in post for over three years but the deputy manager explained that two staff have recently been transferred to other homes within the organisation and on the current weekly rota 10 staff shifts were being covered by agency staff. During the day there are two staff working in the service and at night there is one sleeping in member of staff. The deputy manager explained that there is an active recruitment drive in place. The manager explained that out of the current four members of staff, three have completed the NVQ level 2 or 4 in care. DS0000017458.V325279.R01.S.doc Version 5.2 Page 22 The recruitment checks for staff are held at the head office and were inspected for three staff by information being sent to the CSCI office. The three staff all had a CRB disclosure and two references in place. The record of staff team meetings were inspected and these meetings take place on a monthly basis and discuss the service users and a wide range of operational issues. The induction records were inspected for three staff and were comprehensive and covered a range of operational aspects relating to the home. The staff training records were inspected for three staff members. The staff had received comprehensive training but it was noted for staff who had been in post for several years that some of this training needed to be updated. It was also noted that two of the three staff had not received training on autism, which is an important area to cover in order to understand the needs of the current service users. The staff supervision records were inspected for three staff. All the staff were receiving individual supervision. The home uses a comprehensive supervision format and these were appropriately completed. DS0000017458.V325279.R01.S.doc Version 5.2 Page 23 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service users are benefiting from living in a well-managed service where the focus is on providing a high standard of care and support. Health and safety measures are in place to protect the service users. EVIDENCE: The home has a registered manager and her management skills are reflected in the service which is well organised. The deputy manager did not know if the manager had completed the NVQ level 4. The inspector spoke to a senior manager in the organisation who explained that a quality assurance exercise had taken place across all the homes that sought the views of service users, relatives and other care professionals. A copy of the report was sent to the inspector but it is recommended that the DS0000017458.V325279.R01.S.doc Version 5.2 Page 24 home has a copy to ensure any areas for improvement are being reflected in the service. The home has appropriately reported any serious incidents concerning the service users to the CSCI and completes regular provider monthly visits. Fire safety measures are in place. The fire safety records were inspected and weekly fire alarm checks and fire drills are recorded. It was not possible to tell what time the drills took place and it is recommended that the timing is recorded to ensure these take place at night as well as during the day. The fire alarm, emergency lighting and fire extinguishers had received their annual service. The home has an evacuation plan and fire safety risk assessment. The certificates were in place to confirm the electrical installations, portable electrical appliances, gas and water systems had been serviced. Fridge and freezer temperatures are checked and recorded on a daily basis. Food is appropriately stored in the home. The current insurance certificate was displayed and was satisfactory. The staff training records for four staff were inspected they had all received training on fire safety, food hygiene, first aid and health and safety although some of this training needed to be updated. The records in the home were observed to be well organised and maintained. DS0000017458.V325279.R01.S.doc Version 5.2 Page 25 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. 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 x 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 x 3 x 3 x x 3 x DS0000017458.V325279.R01.S.doc Version 5.2 Page 26 NO 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 YA23 Regulation 13(6) Requirement Timescale for action 31/05/07 2. 3. YA33 YA35 18(1)(a) 18(1)(c) The registered person must ensure all the staff have received training on the protection of vulnerable adults. The registered person must 31/05/07 ensure that the vacant staff posts are filled. The registered person must 31/05/07 ensure staff have all received training on autism and that all training is updated as required. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA17 YA20 YA39 YA42 Good Practice Recommendations The registered person should use less tinned and frozen food and make more use of fresh food in the home. The registered person should ensure the staff all have their medication training updated. The registered person should make a copy of the results of the quality assurance exercise available in the home. The registered person should keep a record of the times of DS0000017458.V325279.R01.S.doc Version 5.2 Page 27 the fire drill to ensure they are taking place at night as well as during the day. DS0000017458.V325279.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 DS0000017458.V325279.R01.S.doc Version 5.2 Page 29 - 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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