Inspection on 05/06/07 for Ghyll Royd House

This inspection was carried out on 5th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Royd House 06/03/06

Ghyll Royd House 01/09/05

Ghyll Royd House 11/03/05

Ghyll Royd House 15/09/04

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

CARE HOMES FOR OLDER PEOPLE Ghyll Royd House New Ghyll Royd Guiseley Leeds Yorkshire LS20 9LT Lead Inspector Catherine Paling Key Unannounced Inspection 5th June 2007 09:20 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 Royd House DS0000001340.V329385.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 Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ghyll Royd House Address New Ghyll Royd Guiseley Leeds Yorkshire LS20 9LT 01943 870720 0113 871212 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) Ghyll Royd Nursing Home Limited Mrs Ann McGregor Care Home 76 Category(ies) of Dementia (15), Mental disorder, excluding registration, with number learning disability or dementia (15), Old age, of places not falling within any other category (61), Physical disability (1), Terminally ill (3), Terminally ill over 65 years of age (3) Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The place for PD is specifically for the service user named in connection with the application dated 13 June 2006 6th March 2006 Date of last inspection Brief Description of the Service: Ghyll Royd House is a 76 place care home for older people, it provides nursing care and has a unit dedicated to the care of people with dementia. The home also has a number of places dedicated to the care of people with terminal illnesses. It was purpose built as a care home and was first registered in 1995. The home is situated in Guisley, a short walk from local shops and facilities including good transport links to Otley, Ilkley, Leeds and Bradford. The building is well maintained and has pleasant gardens. Accommodation is on two floors, there are 72 single and two shared rooms and the majority have en-suite facilities. There are a number of communal areas on both floors, these include large lounges and dining areas and small lounges where residents can sit quietly or meet their visitors. The home has level access and there are two passenger lifts. Car parking is available. The home is internally divided into three units; Yew and Rowan provide general nursing care and Beech is the specialist dementia unit. Each unit has a designated manager who is accountable to the Registered Manager. The Registered Manager is responsible for all aspects of the day-to-day running of the entire home. Information about the service is available in a Statement of Purpose and Service User Guide as well as a home brochure. These documents are reviewed regularly to make sure that the information is up to date. The fees range from £610 to £725 per week. There are additional charges for chiropody hairdressing and newspapers. This information was provided by the service on the pre-inspection questionnaire completed in January 2007. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. All regulated services will have at least one key inspection between 1st April 2006 and 30th June 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people using it. All of the core National Minimum Standards are assessed and this forms the evidence of the outcomes experienced by the people who live at the home. More information about the inspection process can be found on our website www.csci.org.uk This visit was unannounced and one inspector was at the home from 09.20 until 18.00 on 5th June 2007. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live at the home and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. A number of documents were looked at during the visit and all areas of the home used by the people who lived there were visited. A good proportion of time was spent talking with the people at the home as well as with the manager, deputy manager and the staff. A pre-inspection questionnaire (PIQ) had been completed before the visit to provide additional information about the home. Survey forms were sent out to healthcare professionals who visit the home to the home, before the visit. Survey forms for the people who live at the home and their relatives were left at the home for distribution by the manager. Information provided in this way may be shared with the provider but the source will not be identified. A number of surveys were returned and included overall positive comments about the conduct of the home. Some of these comments are reflected in the body of the report. What the service does well: Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 6 Ghyll Royd House provides an excellent environment for the people who live there. The home has wide corridors that create a feeling of spaciousness and allows wheelchair users plenty of space to maintain their independence. It is decorated and maintained to a high standard. There is a friendly and welcoming atmosphere with no restrictions on visiting. The people at the home are treated with respect and dignity and are consulted about how their care needs will be met. Views from health care professionals surveys support this: • • ‘They try to support every individual in the way they choose’ ‘Meets the needs of the individual. Dignity always considered’. General Practitioner survey also included positive responses about the care of the people at the home. For example, ‘I have never had to question the standards of care’ and ‘Clean, healthy, safe environment with good standard of individualised care’. Feedback from relatives indicates overall satisfaction with the care. • ‘Provides a high standard of care in all areas’. • ‘You can tell this is a good home as most of the staff are always smiling’ • ‘We think the food is excellent’ • ‘We are all highly satisfied with the care given’. • The staff ‘know the residents well and cater to individual needs and adapt care as required’. A variety of social activities are offered. These include activities within the home and opportunities to take part in social events outside of the home. A monthly newsletter gives information on events. The home has a good reputation in the local community and some people spoken with were clear that this had been the reason they had chosen to live there. One visitor said they thought the home was comfortable and seemed to have plenty of staff. The home has an excellent training programme and it was clear that staff appreciated this. This means that staff are equipped to care effectively for the people living at the home. What has improved since the last inspection? The home continues to operate at a high level and provides a high level of care for the people living at the home. Since the last inspection the manager has attempted to provide feedback from the surveys to the people at the home, their relatives and the staff. The method chosen, a graph format was not as successful as had been hoped. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 7 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 Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 8 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 Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 9 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 to this service) People who use the service experience excellent quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. All the people who come to live at the home have their needs fully assessed by the nursing staff so that they can be sure that the home can meet their needs. EVIDENCE: All the individual care records looked at included detailed pre-admission assessments. These assessments included good information about the needs of the people coming to live at the home. Additional information from other healthcare professionals, social workers and relatives was also seen in the records, which enhanced the information gathered during the home’s pre-admission assessments. This information was used to develop the individual plans of care. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 10 People who had been admitted in the last few months said that they felt their needs were being met. People who want to come to live at the home are encouraged to visit before making up their mind. Some had been able to do this while others had relied on their families to visit on their behalf. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience excellent quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. Health and personal care needs are met. Care plans provide detailed instructions for staff on how to meet the care needs of the people who live at the home. People living at the home are protected by safe medication practices. The staff respect the privacy and dignity of the people living at the home. EVIDENCE: The individual care records of a small number of people living at the home were looked at in detail. Following admission to the home a further more detailed assessment takes place covering all of the activities of daily living identifying strengths and weaknesses. This results in a useful document that Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 12 provides an overview of the individual care needs and what interventions are necessary. Individual care plans provide detail of the interventions required to support the person to make sure that their care needs are met. Some of these could be improved by the addition of more specific and personal detail about care needs. For example, whether a person prefers a bath or a shower and where a plan states to ‘offer chiropody’ there should be information about the arrangements made for this to take place. The care plans were reviewed and evaluated monthly. Some of these reviews were brief and uninformative but others were good detailed reviews of how effective the plan had been and what progress or changes had occurred. Evaluation of care plans needs to be developed to provide meaningful reviews of the effectiveness of the care plan over the previous month. Nurses are given time to review and evaluate the records. This is good practice. Records seen on the dementia care unit were very detailed and provide excellent information about the person and their care needs. There is a range of risk assessments some of which had not been fully completed others, such as some of the bed safety rails risk assessments, had been carried out to a high standard. The home also seeks the advice of other health care professionals whenever necessary for example the Community Psychiatric Nurses, Tissue Viability Nurses and Dieticians. There was a very good standard of recording in the key workers’ diaries, which provided good insight into the condition of the person living at the home. Each unit has a nominated person to oversee the administration of medicines. The manager and her deputy take the responsibility for the disposal of medicines and make sure that all returns are clearly documented. They have been liaising closely with the chemist to reduce the amount of medicines destroyed. There is a system in place for the monitoring of medication recording. Medication reviews are carried out for some of the people living at the home. There have been some local difficulties with providing medication administration update for the nursing staff but the deputy manager is pursuing this. The most recent update was 14 months ago. Observation of staff practices and discussion with the people living at the home and some relatives indicated that staff treated the people at the home with dignity and respect. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. People who live at the home are able to exercise choice in their daily routines and their social expectations are met. People living at the home are provided with a varied and nutritious diet. EVIDENCE: The people at the home are supported and encouraged to exercise choice in their day to day routines. Some people were enjoying late breakfasts on the day of the visit. Visitors are made very welcome at the home at any time and people at the home maintain links with the local community. Those people who are able go out of the home to attend church services and for those who are no longer able to go out other arrangements have been made. Several of the people at the home enjoy sitting out on the attractive paved area at the front of home of the home in the fine weather. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 14 The people and visitors spoken with were very happy with the care received at the home and spoke highly of the staff, saying for example, ‘nothing is too much trouble’ and ‘you couldn’t get kinder carers’. There are two activities organisers at the home, one based on the dementia unit for 12 hours a week and one who works across the other two units for a total of 30 hours. The new activities organiser for the general units had just started and was on induction on the day of the visit. There is a range of activities on offer at the home including such things as bingo, carpet bowls, quizzes, board games and coffee mornings. On the day of the visit people on the dementia unit were engaged in making birthday cards. A newsletter is produced to inform the people at the home about activities, forthcoming birthdays and quizzes. The records about residents’ participation in social activities were not up to date in the care plans looked at. This reflects the gap between the previous activities organiser leaving in April and the new member of staff starting. The home has a four weekly menu and this shows that a varied and balanced diet is offered to the people at the home. There are separate menus for vegetarian and soft options. The menus are reviewed and changed regularly and the people at the home are consulted about their likes and dislikes. People are encouraged to drink plenty and are offered nourishing snacks between meals, including home baking. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience excellent quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. The adult protection and complaints policy and procedures make sure that people are listened to and are protected from abuse. Staff knowledge and training makes sure that people can feel protected and safe. EVIDENCE: There have not been any complaints since the last inspection. There is a complaints procedure displayed in the home. People at the home and relatives spoken with were clear about who they would speak to if they had any concerns. All those spoken with were confidant that they would be listened to and that any issues would be dealt with appropriately. The manager and her deputy have a visible presence in the home and actively encourage the people at the home and their relatives to discuss any issues or concerns. One relative survey returned to the CSCI made a suggestion that notices be put in the bedrooms outlining the complaints procedure. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 16 The deputy manager has had training by the local authority enabling her to cascade training about adult protection to the staff at the home. Information used in the training and staff knowledge indicates a good understanding of adult protection. The people living at the home have confidence in the staff and feel well cared for; relatives also said that they have confidence in the staff at the home. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience excellent quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. People live in a safe and well maintained environment. EVIDENCE: All those areas of the home visited were clean and odour free. Effective products were being used in one particular area where there was a slight odour problem. The home is maintained in good decorative order. There are plans for major refurbishment to commence towards the end of 2007 and this will start with redecoration of the communal areas of the home. There are also plans to level the garden area outside the dementia care unit to allow the people who live on the unit safe access to outside space. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 18 Procedures are in place to reduce the risks of cross infection and staff have training on control of infection practices. The laundry is well equipped and was clean and well organised. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience excellent quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. The numbers and skill mix of staff are sufficient to meet the needs of the people living at the home. Staff are well trained and competent making sure that peoples’ needs are properly met. People living at the home are protected by good recruitment procedures. EVIDENCE: Duty rotas indicated that there was enough staff to meet the needs of the people living at the home. Support for the nurses and care staff is provided by a team of domestic and laundry staff, catering staff, two administrators and a maintenance man. The home functions as three separate units and each unit has its own unit manager and dedicated staff team. The deputy manager is responsible for delivering in house training and coordinating external training. An excellent training programme is provided for all designations of staff and over 90 of the care staff have achieved a National Vocational Qualification (NVQ) in care at level 2 with several care staff now part way through NVQ level 3. Ancillary staff have also undertaken NVQ training in relevant subjects. An annual survey is carried out to help in Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 20 identifying staff training needs in addition to mandatory training and to make sure that staff have the skills they need to care effectively for the people who live at the home. New care staff are given a thorough induction programme. The deputy manager shows a clear commitment to the continual development of the training programme and has an NVQ at level 4 in management. She provides a high level of support for staff working at the home and to the manager. The records of recently employed staff demonstrated that all the required checks are carried out before staff start work at the home. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience excellent quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. The manager provides clear leadership, guidance and direction to the staff to make sure that the people at the home receive a good level of care. The interests of the people at the home are very important to the manager and her staff and are safeguarded at all times. EVIDENCE: The registered manager is an experienced nurse. She has been in post for four years and has the necessary management qualifications. She is enthusiastic and committed to the continued improvement of the service and facilities at the home. The manager provides clear leadership to the staff and is supported Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 22 by the deputy manager who also demonstrates a high level of commitment to the home. Part of the ongoing monitoring of the service includes the annual distribution of questionnaires to the people who live at the home, relatives and staff. The results are analysed and have been circulated in graph format, although this has led to some confusion so alternative methods of providing feedback are being considered. Any issues or concerns identified through the survey are addressed. Formal meetings for the people at the home and their relatives are held once a year and notes are kept. The manager and her deputy both have a high profile in the home and are readily available to the people at the home and their relatives. Regular staff meetings are held for all grades of staff and notes are also kept of these meetings The home does not get involved in managing residents finances and does not act as “appointee” or “agent” for anyone living at the home. Small amounts of spending money are held for some people. All transactions are recorded and receipts are available for all money spent on behalf of anyone living at the home. Information given in the pre-inspection questionnaire provided evidence that all the required health and safety and maintenance checks are carried out at the home. Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 4 X X 3 Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The manager should work with the nursing staff to make sure that the evaluation of care plans provides a meaningful review of the effectiveness of the care plan over the previous month. Guidance should continue to be provided for nursing staff about record keeping to make sure that there is a consistently high level of recording. Consideration should be given to putting notices in the bedrooms outlining the complaints procedure. 2 OP16 Ghyll Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 25 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 Royd House DS0000001340.V329385.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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