Inspection on 08/03/07 for Ghyll Court

This inspection was carried out on 8th March 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ghyll Court 09/03/06

Ghyll Court 05/10/05

Ghyll Court 18/02/05

Ghyll Court 01/09/04

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

CARE HOMES FOR OLDER PEOPLE Ghyll Court The Wells Walk Ilkley West Yorkshire LS29 9LH Lead Inspector Liz Cuddington Key Unannounced Inspection 8th March 2007 13:00 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 Ghyll Court DS0000001279.V325628.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. Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ghyll Court Address The Wells Walk Ilkley West Yorkshire LS29 9LH 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) 01943 607059 01943 607059 Mrs Jane Mary Verfuerth Mrs Jane Mary Verfuerth Care Home 14 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (14) of places Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th March 2006 Brief Description of the Service: Ghyll Court is a converted, extended property situated close to Ilkley town centre. It was first registered in November 1989 and bought by the present owner in 2001. The owner, Mrs Verfuerth, also manages the home. The home provides personal care and support for 14 older people who do not require nursing care. There are twelve single bedrooms and one twin bedroom, most rooms have en-suite facilities. The home stands in attractive gardens and is within easy reach of Ilkley Moor, the railway station and public transport links to Leeds, Bradford and Skipton. The fees are between £400 and £500 per week. Hairdressing, chiropody and personal items are extra. Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group, for example ‘Choice of Home’, and ‘Health and Personal Care’. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers these outcomes to the people who use the service. The judgement categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded in the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk This purpose of the inspection was to look at how the needs of the people living in the home are being met. The methods I used to gather information included conversations with residents, relatives and staff, case tracking, examining records and touring the home. Questionnaires were sent out for residents and their relatives to complete and a pre-inspection questionnaire was sent to the home. These questionnaires provide valuable information to help me make a judgement about the quality of care and support the home offers. At the end of the inspection visit I left an ‘Immediate Requirement’ notice, requiring the home to fit a lock to the medication room door, to make medicine storage safe. This requirement was acted on within the given timescale. I would like to thank the ladies and gentlemen who live at Ghyll Court, and all the staff, for their welcome and hospitality during my visit and for taking the time to talk to me. What the service does well: Residents and relatives told me that they are satisfied with the care and support they receive at Ghyll Court. One relative wrote “Ghyll Court, Ilkley is an excellent, friendly, welcoming home”. Other people told me they enjoy the activities and they like the meals. Residents said that the staff are kind and helpful and I observed that staff treat people with respect, consideration and courtesy. The atmosphere in the home is warm, calm and relaxed. The owner, who is also the manager, sets the tone of the home where the residents’ needs and preferences are central to everything they do. The staff reflect this in their work and they all clearly understand how to care for and Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 6 support each individual. Independence is promoted and I noted several circumstances where this approach has achieved positive results. There is a range of activities available, either with the help of the home’s staff or with a visitor such as an entertainer or an exercise leader. The home is well decorated and is clean and hygienic throughout. What has improved since the last inspection? 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. Ghyll Court DS0000001279.V325628.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 Ghyll Court DS0000001279.V325628.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 Standard 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed before moving into the home to make sure that staff can meet their needs. EVIDENCE: Pre-admission assessments are completed for prospective residents of Ghyll Court. The residents’ questionnaires confirmed that they received the information they needed to help them make a decision about moving in. The manager prefers the person to visit and perhaps stay for a meal, to allow him or her to gain a proper feel for the home before making a decision. If this is not possible then senior staff will visit the person in their own home or in hospital. The same procedure applies for people who go to Ghyll Court for a respite stay. The assessment is reviewed at a later date. Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are at risk of not receiving care and support in the way they wish because the care plans do not show in sufficient detail how their needs are to be met by staff. Residents’ health and safety is at risk because medications are not being stored or administered safely and records are not accurate. Residents’ dignity and privacy is maintained because staff understand their needs and treat them with respect. EVIDENCE: During the inspection I saw that staff are considerate and respectful towards the residents at all times. The staff that I spoke with, and observed all showed a good understanding of the needs of each resident. The comments that Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 10 people made to me during the inspection visit and in the questionnaires confirmed this. I looked at a number of residents’ care plans. The system of having a summary of each care plan easily available for reference, and keeping the more detailed plans in separate files is good. However the plans that I looked at are very minimal and do not show in sufficient detail how each person’s care and support is to be provided. There are assessments in place for some areas of care such as continence and pressure area care, but there are significant gaps in the assessment process. There are few risk assessments, even when an individual’s health and lifestyle show that it is essential that these should be completed. For example, when someone wishes to undertake an activity where there is an element of potential risk, an assessment must be completed to make sure that all the risks are evaluated and understood. This does not mean that the activity should be prevented or curtailed, but it documents the risks and benefits to the resident and allows a balanced judgement to be made. The assessment can also consider any potential risks to others, including other residents. Wherever possible, the resident should be involved in the risk assessment process, as in all other aspects of their care planning. There are only moving and handling plans in place for those residents who need to use a hoist. To make sure all residents receive safe and consistent support when being assisted with any aspect of their mobility, a detailed plan needs to be drawn up to guide staff in how to provide the necessary assistance. Each individual’s personal hygiene routine and preferences are recorded. Independence in all aspects of residents’ daily lives is promoted. In most cases the care plans refer to, and document, when professional healthcare advice has been taken, and the outcomes. There was a significant omission in one person’s healthcare records. This could affect staff’s understanding of the individual’s needs and the extent of professional healthcare involvement. Although the daily records show, where necessary, the food intake of residents there was no nutritional assessment in place for one person whose nutritional balance and health was at risk. Daily records are written for each resident. Although each care plan is reviewed regularly by the staff, I did not see evidence to show that in every case the service user or their representative had been involved in developing and reviewing their plan. Where this involvement is not possible the plan should record this. Since the inspection visit the manager has informed me that all residents, or their representatives, have signed their care plans. Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 11 The small room where the medication is stored was not locked. The manager told me the lock was broken. There is a locked cupboard inside the room where the medicines in daily use are stored. There was also a considerable amount of additional medication kept in the room, which was not in the locked cupboard. This included unused medicines waiting to be collected by the pharmacist, as well as some other medicines. For the safety of residents, all medicines must be securely stored, in accordance with the Royal Pharmaceutical Society’s guidance. An Immediate Requirement Notice was left, requiring the home to fit a lock to the medication room. This was implemented within the required timescale. A significant amount of medicine was kept in the medication room, which was not in regular use by the people for whom it had been prescribed. These medicines need to be recorded and returned to the pharmacist. By the end of my inspection visit the manager had removed all the unsecured medicines and had stored them in a safe place. I checked the quantities of medicines in stock for a number of people against the amounts received and numbers administered. There is no ‘brought forward’ system for medicines that are not supplied in the monitored dosage system, including medicines such as paracetamol and senna, which are only taken when required. This made it impossible to audit the quantities of tablets or liquid medicine administered, against the quantities received and quantities remaining. All medicines received and administered must be recorded on the Medicines Administration Record (MAR) charts, including any quantities still in stock. Staff must also sign against each dose of medicine to confirm that it has been administered, or not, in the amounts and at the time prescribed by the Doctor. There were some signatures missing on the MAR charts. Ghyll Court DS0000001279.V325628.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to choose how they spend their time. A range of activities is available. The meals are of a high standard and mealtimes are relaxed. EVIDENCE: From my own observation, and comments made by the ladies and gentlemen who live at Ghyll Court, the residents are able to exercise their personal choice in all aspects of their daily lives and staff respect that choice. After tea I saw a group of residents enjoying playing dominoes together, and this was clearly a regular part of their daily lives. In the afternoon an entertainer visited the home and sang songs and did a quiz. One resident told me that he comes every month. Other people go out either alone or with their families. Staff accompany residents for a walk, if the resident wishes. Other regular activities include music, crosswords and armchair exercises. The local church also visits to offer communion to the residents. Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 13 There were lots of visitors arriving to see residents during the time I was at Ghyll Court, and they were all made welcome. The mealtimes are relaxed and, where people eat together in the dining room, they are sociable occasions. If they prefer, residents can eat in the lounge or in their bedrooms. Assistance offered by the staff to people who need help with their meals is given discreetly. The menus are varied and alternatives are available if someone does not want the main course or dessert on offer at lunchtime or teatime. There is also a choice of food at suppertime. Breakfast is served on trays to residents in their bedrooms. Drinks and snacks are always available. The people I spoke to said that the meals are very good. The people who completed the questionnaires I sent out also said they either always, or usually, liked the meals. One person confirmed that staff are always willing to make snacks and drinks, when asked. Ghyll Court DS0000001279.V325628.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are aware of how to make a complaint. Staff understand the adult protection policies and procedures, which makes sure that people living at the home are safe. EVIDENCE: The returned questionnaires confirmed that people generally know how to make a complaint or raise a concern if they need to. The complaints procedure is detailed in the Statement of Purpose and Service Users Guide. The home has adult protection and ‘whistle-blowing’ policies and procedures in place that cover the way any concerns or allegations of abuse or poor practice would be handled. Protection of Vulnerable Adults training had been taken by some staff and further training was planned for the remaining staff. The manager has taken the Adult Protection for managers course. Ghyll Court DS0000001279.V325628.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The house and grounds are well maintained, attractive and accessible. There are suitable adaptations fitted. The bedrooms are well furnished and comfortable. The whole house is clean and hygienic. EVIDENCE: The home is clean, tidy and fresh throughout and this view was confirmed by comments from residents and relatives. There is a welcoming and homely atmosphere and the house is well decorated. All the rooms have been redecorated during the last few years. The bedrooms are comfortably furnished and are light and spacious. The furniture and bedding is of good quality and the rooms I saw contained personal items, reflecting the interests and personality of the resident. Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 16 The garden at the front of the house is attractive and many people like to sit out there during the better weather. Although there are steps leading from the front door, level access to the garden is gained by going out of the back door and walking round to the front. Some bedrooms are on the ground floor and there is a chair lift to the upstairs bedrooms and bathrooms. Ghyll Court DS0000001279.V325628.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are employed in sufficient numbers to meet the needs of the residents. Mandatory CRB and POVA checks have been carried out, but not all staff files show that all other recruitment procedures have been completed. There is suitable training available to give staff the knowledge and skills to provide good, safe care and support for the residents. The files contained the necessary records of training taken by staff. EVIDENCE: There are enough staff on duty at all times to meet the needs of the residents and the home. The home does not use agency staff. Members of the staff team provide additional shift cover. I looked at a selection of staff files. The records for staff recruited by the present owner showed that all pre-employment checks are satisfactorily carried out. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks had been obtained for all staff. The dates of these checks need to be noted in the files. I was assured that no new staff would start work until a POVA register check had been completed. Then, if the CRB Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 18 check had not been received, they would work only under the supervision of an experienced staff member. The Manager and the Deputy Manager are qualified nurses. Four of the nine care staff have a level 2 National Vocational Qualification (NVQ) in care, one has also achieved the level 3 award. One other staff member is working towards achieving the level 2 NVQ in care. The manager works hard to make sure that staff have all the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. Staff have recently completed training in managing challenging behaviour and dementia care training is planned for the near future. The staff are up to date with the mandatory training such as basic food hygiene, first aid, fire safety and health and safety. The staff who commented said they enjoy working at Ghyll Court and feel that they receive the support they need to do their job well. Ghyll Court DS0000001279.V325628.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and the quality assurance systems are effective. Hot food, refrigerator and deep freezer temperatures are not always being taken daily, to make sure food is stored and prepared safely. The kitchen is clean and hygienically maintained. Health and safety checks and policies and procedures are up to date. EVIDENCE: The manager has the experience and qualifications necessary to manage the home effectively. The manager attends additional training to keep up her professional development. Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 20 There is a range of quality assurance measures in place including questionnaires, which are sent to residents, relatives and visiting professionals. The manager acts on the information to improve service quality for the residents of Ghyll Court. The manager, who is also the owner of the home, is available all the time for staff to discuss any issues they may have. At present one to one staff supervision is not taking place every two months, to give staff a more formal opportunity to discuss their development, training and other work-related needs with their line manager. The Deputy Manager makes individual supervision notes referring to her observations of care practice. There are records to show that routine maintenance and safety checks are carried out. The home’s policies and procedures have been updated within the last twelve months. The home’s kitchen is clean and well organised. Refrigerator, deep freezer and hot food temperatures are not taken and recorded every day, in order to make sure that food is being stored and prepared safely. The home is secure and safe. Ghyll Court DS0000001279.V325628.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 X X 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 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 3 X 3 X 3 2 X 3 Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Timescale for action All the residents’ care plans must 31/05/07 be reviewed, to make sure they include all the necessary information to guide staff in how to care for and support each individual. To ensure their health and 30/04/07 safety, all residents’ care plans must include comprehensive risk assessments and healthcare assessments, where the person’s needs and lifestyle demonstrate this is required. Wherever possible, the resident 31/05/07 or their representative must be involved in developing and reviewing their care plan. This must be clearly recorded on the care plan to show that the resident, or their representative, has been central to planning and reviewing how their health and care needs are to be met. To protect the health and safety 12/03/07 of residents, all medication must be securely stored at all times. All medicines received, held in 30/04/07 stock and administered must be accurately recorded and staff DS0000001279.V325628.R01.S.doc Version 5.2 Page 23 Requirement 2. OP7 13(4) 3. OP7 15(1) & 15(2)(c) 4. 5. OP9 OP9 13(2) 13(2) Ghyll Court must sign to confirm each stage of administration. This is to show that medicines have been administered correctly and to provide a clear audit trail of all medicines received, held in stock, administered and returned to the pharmacist. 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. Refer to Standard OP36 OP38 Good Practice Recommendations All care staff should have one to one supervision with their line manager at least six times a year. Refrigerator, deep freezer and hot food temperatures should be recorded as recommended by the Environmental Health Officer. Ghyll Court DS0000001279.V325628.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Ghyll Court DS0000001279.V325628.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. 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