Inspection on 31/10/05 for Gorselands

This inspection was carried out on 31st October 2005.

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 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

Gorselands 03/07/08

Gorselands 31/07/07

Gorselands 01/08/06

Gorselands 07/02/06

Gorselands 27/01/05

Gorselands 15/04/04

Gorselands 28/10/03

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

CARE HOMES FOR OLDER PEOPLE Gorselands 25 Sandringham Road Hunstanton Norfolk PE36 5DP Lead Inspector Chris Handley Announced 31 October 2005 9.30am 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 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. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Gorselands Address 25 Sandringham Road Hunstanton Norfolk PE36 5DP 01485 532580 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) cieves@ntlworld.com Cieves Limited Care Home 21 Category(ies) of Old age (21) registration, with number of places Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27 January 2005 Brief Description of the Service: Gorselands is a large detached residential home of 21 beds situated in Hunstanton, which provides care for elderly ladies. The accommodation is on the ground and first floors with a shaft lift to access the first floor. There are 17 single rooms and two double rooms. Eight of the bedrooms have en suite toilets. There are assisted bathrooms and toilets. The communal areas consist of a large lounge and dining room, both of which have good natural light and overlook the garden. There is a large paved car parking area at the front of the home. The gardens which are well maintained have a range of ornamental flowers and a fountain. The garden at the rear of the home is suitable for wheel chair users. The home is adjacent to the facilities and seafront of Hunstanton. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which was part of the annual inspection programme. The inspection commenced at 9.30 and was completed at 3.30. Seven residents and seven relatives were interviewed by the Inspector who also interviewed five members of staff. The Inspector made a tour of the home escorted by the Proprietor. A wide range of documentation was seen and examined. Comment cards were received from thirteen relatives, all of whom knew that this inspection would be taking place. In the inspection dated 27/1/05 1 Requirement and 14 recommendations were made, and the Proprietors are commended for fulfilling them. What the service does well: What has improved since the last inspection? • • • The activities provided in the home are better publicised within the home than previously. The practice of confidentiality has been improved since the last inspection. All staff have been provided with Prevention of Abuse training. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2 &3 All residents are provided with a Statement of Purpose and Services Users guide. All residents have a Contract. A pre-admission assessment is carried out on all prospective residents. EVIDENCE: In the inspection dated 27/1/05 it was noted that the residents were not given copies of the Service Users Guide, and requirement was made that they should be given copies of this documentation, this is now done. The documents concerned are well set out and comprehensive, and can be read by people who may have poor sight. Staff interviewed were aware of this document and the purpose of it. Some of the residents interviewed were also aware of this document and a number of copies were seen by the Inspector in residents’ rooms. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 9 All residents are given a contract the Proprietor said, and showed the Inspector a copy of one such document. The Proprietor said that she reads through the document with the residents to ensure their understanding of the content. The document is clearly set out in easy to read print. The residents, and in many cases, the relative, keep the document, the Proprietor said. A signed copy is kept in the office. Visitors interviewed, were aware of the Contract when asked about it by the Inspector. Staff interviewed knew that the residents have contracts and that they are important documents for them. A pre-admission assessment is carried out on all prospective residents, the Proprietor informed the Inspector. The Proprietor told the Inspector that she carries the pre-admission assessments. The Inspector saw the document. In the inspection dated 27/1/05 it was recommended that this document be headed “Confidential Information” because of the content that it is likely to contain when completed, and that the assessment should include a social skills/interest assessment. Both of these recommendations have been put into place, and were seen by the Inspector. Staff interviewed were aware that these assessments take place and the reasons for them. Residents and relatives interviewed by the Inspector were aware of these assessments and why they are carried out, some recalling them being carried out. Prospective residents and their relatives, are welcomed to visit the home prior to admission. The Proprietor sees the importance of these visit saying that “It is no good a person coming into home that they don’t like”. The prospective residents, along with their relatives, tour the home, meet and talk with other residents and staff. They are provided with information and refreshments. Sometimes a second visit is made, the Proprietor said. Some of the residents interviewed by the Inspector, recalled making these visits. Some relatives told the Inspector that they had visited several homes to ensure as far as was possible that they got the right home for their relatives. Staff interviewed are very much aware of the importance of the visits, “It is going to be their home so they need to ensure that they make a choice of home that they like” one said. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 & 9 All residents have an individual care plan. The health care needs of residents are fully met. The home has a safe and effective medicine system. EVIDENCE: The care plans have the essential elements of assessment, planning, implementation and review, and the management of the home have appointed a member of staff who has responsibility for care planning. There then follow a wide range of assessments these include Pressure Sore Assessment, Falls Risk Assessment, and Moving and Handling Assessment. There is also a geographical hazard assessment of 32 areas of the home in which the resident may be at risk. There is an action plan, steps to be taken by members of staff, and an action plan to be completed by the management of the home. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 11 The elements of the care plan need to be more distinct, e.g. What does the Assessment (Physical, Mental, and Social) show – what are the needs? The Plan, what does the assessment show, what needs to be done? Implementation, who is going to do what, and when? Review, did the plan work? Is the resident/relative involved in the review, and did they sign to that effect? The care plans were previously kept in an individual ring binder folder. They are now kept in folder which contain six sets of care plans in each one. The folders are clearly marked Confidential. The Inspector strongly recommends that the home moves back to having individual files so that these can easily be accessed by the resident and their relative if needed. The health care needs of residents are fully met, based on the documentation seen and what the Inspector was told. Personal care needs are assessed and care is provided by staff who are trained and able to provided it. There are no residents who have pressure sores the Proprietor said. Detailed care is provided to those residents who have frail skin and may be susceptible to pressure sores. If needed the District Nurse would be asked to attend. The home has a wide range of preventative equipment in the form of mattresses, hoists and cushions (seen by the Inspector). The Continence Adviser is requested to attend if a resident is admitted who has incontinence. If needed Diabetic advice is sought. Optical and dental services would be arranged if needed. All residents have a GP, who would refer residents to a specialist service required. Residents told the Inspector that if they were not well the staff would get the doctor for them, or send them to the hospital to be seen. Visitors informed the Inspector that they were informed by staff if their relative visits the doctor, or goes for any form of treatment. All 13 comment cards received indicated that the writers of the cards were kept informed of important matters affecting their relative, all said they are satisfied with the care provided. The home has a new medicine trolley which is kept locked. It is the Proprietors intention to have the trolley clamped to the wall when not in use. It is recommend that this is done. There were no loose or unidentified medicines in the trolley, which was neat and tidy. The home has an Monitored Dosage System and the records for this were seen by the Inspector. They were neatly completed with initials. All staff who administer medicines have been trained for this task. Medicines are reviewed by the GP from time to time, the Senior Carer informed the Inspector. There were no Controlled Drugs in the home on the day of the inspection. The home has a good relationship with the supplying pharmacist the Senior Carer said. If staff had any concerns about the effect of medicines on residents they would contact the prescribing GP, the Senior Carer said. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14 &15 There is a wide range of activities in this home which both give stimulation and enjoyment to residents. Residents have a wide range of choice in their lives. The home provides a good catering service. EVIDENCE: There is a wide range of activities provided within the home the Proprietor said, including Physical movements, Friendly Faces, Music and Movement, and a wide range of other activities. These activities are much better publicised within the home since the last inspection, and this fulfils a recommendation made in the inspection dated 27/1/05. A copy of the “Activities Calendar” was seen by the Inspector, this shows the wide range of activities that are provided. Relatives are kept informed of activities, by reading the Activities Calendar which is displayed in the home. On the afternoon of the inspection, the Inspector briefly witnessed a lively “Sing Song” taking place in the sitting room, a large number of residents taking part with obvious enjoyment. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 13 Two visitors told the inspector that this “Sing Song” had not been put on for his benefit, as they were a common feature in the home. Representatives of religious organisations a visit the home on a regular basis, the Proprietor said. Relatives take residents out in the summer to the seaside, Lavender Fields or other places of interest, the Proprietor said. This was confirmed by relatives spoken to. Residents choose when they get up in the morning, the Proprietor said, adding that she is aware of the danger of older people staying in bed for overlong periods of time. They also choose when they go to bed, they choose what they eat, what they wear, the style of their hair, and which hairdresser does their hair for them. Many residents choose to have help from their relatives to help them with their money. Residents can spend time in their rooms or in one of the communal rooms. The residents and in some cases their relatives confirmed what the Proprietor had said. A number told the Inspector that when they go to their room in the evening, they sit quietly and watch television or read, and that there is no set time to go to bed, and that it is for them to decided this. Relatives spoken to confirmed this approach. One relative said, “Mum decides what she wants to do, when she wants to”. The Inspector saw the menus, which appeared varied, nutritious and interesting. Special menus are provided and recorded; this fulfils a recommendation made in the inspection dated 27/1/05. The residents spoke very highly of the meals, “they always taste very nice”, there is always enough” were two of the comments made. Residents are asked on a daily basis what they would like for their meals. The Inspector spoke to the cook who is aware of the importance of providing nutritious, and interesting meals for older people. The relatives interviewed spoke highly of the meals, both in quality, quantity and variety. The Proprietor said that if needed she would seek advice from the Dietetic Department of the Queen Elizabeth Hospital in King’s Lynn. It was clear to the Inspector that, from the residents’ point of view, they enjoy a good quality of catering service. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The home has an effective complaint procedure. The home has provided training for staff in Adult Abuse prevention. EVIDENCE: The home has a complaint procedure which is contained in the Services Users Guide, which was seen by the Inspector. In the inspection dated 27/1/05 it was recommended that this procedure should be included in the Service User Guide and that it should also have a time scale. Both these factors have been added since. There have been no complaints made since the last inspection, the Proprietor said. Staff interviewed knew how to make a complaint as did relatives and residents. All 13 of the comment cards state that the writers are aware of the homes complaint procedure, but none had ever had to make a complaint. The Proprietor intends to place a copy of the complaints procedure in the porch of the main entrance, and the Inspector supports this idea. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 15 The home has a policy for dealing with Adult Abuse. There have been no cases of abuse since the last inspection, the Proprietor said. All staff have been provided with training in Adult Abuse Protection. Staff told the Inspector that they would not hesitate to report such abuse. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21 & 23 There are sufficient toilets in the home which are all in good working order and decorative condition. The residents’ rooms are of a high standard, and residents have personalised them. EVIDENCE: There is a wide range of toilets located through out the home. These facilities were seen by the Inspector when he carried out a tour of the home. On the morning of the inspection these facilities were neat, clean and odour free. The toilets meet the needs of residents. In the report dated 27/1/05 mention was made that some WCs were being used to store items, “Inco pads” etc. Since then the Proprietors have had shelving put up in a cupboard, which was seen by the Inspector, this appears to have resolved the situation. The Proprietor is aware however of the need to monitor this. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 17 The Inspector made a tour of the home accompanied by the Proprietor and most of the residents rooms were seen. The rooms are of a high standard, they were neat, clean, tidy and are in a good standard of decoration. The residents have personalised their rooms, with photographs, ornaments etc. The rooms have good natural light The doors of residents’ rooms have locks. The Inspector observed that staff have the good practice of knocking on doors prior to entering. In the inspection dated 27/1/05 mention was made of the carpet, and carpet protection in one room. The carpet in question has been replaced, and there is also discreet protection in place. This has enhanced the appearance of the room concerned. Residents and relatives spoke very highly of their rooms and felt that they were very comfortable. The Inspector recommends that residents have name plates put on their doors. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,&28 There are adequate staff working in the home. There is an NVQ training programme in place. EVIDENCE: The Proprietor informed the Inspector of the staff on duty on the morning of the inspection, which were 3 carers, 1 cook, 2 domestic staff, 1 Care/Admin person and the Proprietor. During the day the other Proprietor called into the home. There appeared to be sufficient staff to meet the needs of the residents. These figures agreed with the rotas seen, and the staff seen by the Inspector in the home during the process of the inspection. At night there are two waking staff until 11 PM till 6AM, when one member of staff sleeps in. The Proprietor is on call. All 13 comment cards indicated that in the writer’s opinion there were always sufficient numbers of staff on duty. Resident and relatives interviewed, said that in their opinion there were sufficient staff in the home, and said that residents did not have long to wait if they rang the bell, and the Inspector saw this in practice during the day. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 19 The Proprietor said that there are 7 members of staff who are taking NVQ 2, and there are 2 members of staff who have NVQ 2. There is 1 member of staff who has NVQ 3. These figures represent a big increase in training in this area since the last inspection dated 27/1/05. Staff interviewed confirmed to the Inspector that they were undertaking this training. The Inspector appreciates the difficulties that training of this nature can present to people who lead busy lives, and they and the Proprietor are commended for this and are urged to continue with this training programme. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,36, &37 The home has a quality assurance system in place. The residents best interest are safeguarded by the practices of the home. Staff receive supervision. Residents’ rights are protected. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 21 EVIDENCE: The Proprietor has a system of reviewing the quality of the services the home provides. Questionnaires are sent to residents and on return they are examined closely by the Proprietor, who compares the replies with the previous ones which had been sent out, and returned. She looks for improvements in the service. The Proprietor also has a Quality Assurance Checklist which she carefully goes through in order to monitor the services of the home. The Inspector was shown the content of the file. The documentation used is kept in a dedicated file in the office. Staff supervision takes place and the records of this are of a high quality (seen by the Inspector). The records are well maintained and clearly written. It is the Proprietor intention that in developing staff skills she may at some stage delegate this task to a senior member of staff, following training. Staff interviewed confirmed the supervision takes place, and that they found it helps with defining training needs, and they also find out how they are getting on. The home does not hold money on behalf of residents, and this has been the case since the present Proprietors purchased the home. In the inspection date 27/1/05 a recommendation was made that this should be put in the Service Users Guide. This has since been done and it was seen by the Inspector, this fulfils the recommendation made. Some of the relatives spoken to confirmed that they deal with “Mother’s money.” A wide range of records required by regulation were seen by the Inspector during the process of this inspection. Residents have access to their records if they wish to, the Proprietor confirmed, adding that none had requested to do so. Individual records are up to date and are kept secure and are maintained in accordance with the Data Protection Act 1998. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION x x 3 x x 3 x x STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 3 3 x Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 23 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 Regulation None 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. 2. 3. 4. 5. Refer to Standard 7 9 18 24 28 Good Practice Recommendations It is recommended that the care plans be kept in individual files which are clearly marked with the name of the resident and Confidential Information. It is recommended that the medicine trolley be clamped to the wall when not in use. It is recommended that the Proprietor undertake training in Adult Abuse Protection. It is recommended that residents have name plates on the doors of their rooms. It is recommended that the NVQ training programme continues. Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gorselands I55 S37280 Gorselands V237078 311005 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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