Inspection on 12/07/05 for Great Western Road, Flat 4, 22-24

This inspection was carried out on 12th July 2005.

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

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

Other inspections for this house

Great Western Road, Flat 4, 22-24 29/05/07

Great Western Road, Flat 4, 22-24 06/09/06

Great Western Road, Flat 4, 22-24 17/01/06

Great Western Road, Flat 4, 22-24 23/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 FLAT 4, 22/24 GREAT WESTERN ROAD FLAT 4 22/24 GREAT WESTERN ROAD LONDON W9 3NN Lead Inspector Ffion Simmons Unannounced 12 July 2005 10:00 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Great Western Road, Flat 4 Address Flat 4, 22/24 Great Western Road London W9 3NN 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) 020 7289 4752 020 8964 5507 The Westminster Society of People with Learning Disabilities Ms Amanda Dawn Stevens CRH 6 Category(ies) of Learning Disability (6) registration, with number of places FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 4 March 2005 Brief Description of the Service: Flat 4 is a purpose built, wheelchair accessible, second floor flat that is registered to provide care for 6 people with learning disabilities. The property is owned by Paddington Churches Housing Association and the care is provided by the Westminster Society for People with a Learning Disability, a voluntary organisation. The home is located in a residential area of Westbourne Grove, close to shops and transport links. The home is part of a small residential block that includes a second registered care home and six flats for people with a learning disability who are living independently. Each person living in the home has their own bedroom. Communal areas, bathrooms and toilets are shared. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 12th July 2005 between 10am and 13.45pm. The inspector had the opportunity to meet three of the service users, talk to staff and observe some care practices. Documentation and records were also checked as part of the inspection process. The Commission is awaiting a completed inspection questionnaire from the home. What the service does well: What has improved since the last inspection? The home has met three of the eight requirements set at the last inspection. There is now a full and permanent staff team employed at the home, which has had a positive effect on the service users living at the home and has enabled the Manager to manage the home more effectively. The formation of a permanent staff team has also enabled support workers to look into opportunities for service users such as holidays and day trips which was proving difficult before. The risk assessments for all but one service user have been reviewed to reflect their changing needs. Staff are now clearly noting the date of opening medication bottles. The source of the water damage has been identified, and major building work has been completed to rectify the cause. The condition of the environment has enhanced. New Carpets have also been fitted to the main hallways. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 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. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 4 A good level of information is available for all interested parties about the home and the services it provides. This information is missing details about the manager and the management structure. Opportunities are available for prospective service users to visit the flat prior to moving in. The enables prospective service users to get to know staff, other service users and to get familiar with the environment. EVIDENCE: There is a statement of purpose and service user’s guide available for service users, prospective service users and any other party who is interested in getting to know what services are being offered at Flat 4. There has been an organisational restructure and a new management structure introduced. Details of the restructure and management responsibilities including the manager’s qualifications must be outlined within the statement of purpose. This requirement is being repeated for the second time. Currently there are five service users living at Flat 4. Staff confirmed that a couple of prospective service users have visited the home to view the facilities and to meet the service users and the staff team prior to making a decision about moving in permanently. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 The individual plans are person centred and detailed but need to be in a format which is accessible to service users. Meetings to review personal plans for some service users are overdue and must be scheduled to ensure that the needs of the service users are reviewed. There is one risk assessment, which has not been updated and must be done to identify risks and minimise these risks and to promote service user’s safety. EVIDENCE: The individual support profiles of 3 service users were seen during the inspection. Each service user has a very detailed individual plan, which outlines their main care needs including health and medication, personal care needs, social and leisure activities, living arrangements and education and career. The plans are person centred and reflect that service users’ wishes have been taken into account. The recommendation of the last inspection remains which is that consideration should be given to find ways of making the ISP available in a format that service users can understand. Although individual plans were up to date and daily logs completed, one of the service users has not had a formal multi-disciplinary review since May 2003 and another service user’s IP meeting was last held in January 2004. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 10 The risk assessments of two of the three service users checked had been recently updated and some work was being completed on the third risk assessment. This risk assessment must be completed without any further delay as this requirement is being repeated for the second time. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14, Service users are well supported to access their programme of activities and to take part in the local community. EVIDENCE: When the inspector arrived at the home, three of the service users were attending their day service. The other two enjoyed a lay-in and breakfast in bed was offered. One of the service users does not attend the day service on Tuesdays, but takes part in a choice of activities, which was a walk along the canal that day. Each Tuesday afternoon, three of the five service users have a massage. Each service users living at flat three have a full programme of appropriate activities and are supported to be part of the local community. The formation of a full and permanent staff team has enabled support workers to look into opportunities for service users such as holidays and day trips. Service users’ individual abilities and highlighted in individual plans. housekeeping responsibilities are FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Service users’ personal care, physical and emotional needs are well documented and a key working system is in operation to promote continuity of care. Although service users have access to the multi-disciplinary team, dental and optical checks are overdue and must be scheduled to ensure the healthcare needs of the service users are met. The system for managing the medication is good but staff must ensure that when the code F is used for not administering medication, this must be defined. EVIDENCE: Service users’ personal care needs are outlined in the personal plans and staff were observed to be respecting service users’ privacy. Key working systems are in operation to aid continuity of care. The healthcare records of three service users were checked during the inspection. Service users have access to the input of the multi disciplinary team. Service users’ optical and dental tests are overdue. This requirement is being repeated for the second time and requires urgent action. The medications arrive into the home in blister packs and are securely stored in a metal cabinet within a locked store cupboard. The medication records of all service users were checked and were found to be well completed. It is a requirement, however that when the code F is used, the reason why the medication was not administered should be defined on the MAR sheet. Staff FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 13 are noting the time of opening medication bottles on the label as per the requirements of the last inspection report. Service users’ wishes regarding death and terminal care are still not confirmed and service users must be consulted with. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 There is an accessible complaints procedure and there was some evidence that service users are supported to make a complaint. It was difficult to establish from some of the complaint documentation how a complaint had been investigated and what the outcome of this complaint was. The complaint documentation must be improved. There is a policy available for staff on physical intervention and restraint. EVIDENCE: The home has a complaint procedure which is accessible to service users. Evidence was also available within the minutes of house meetings that service users are supported to make a complaint and are reminded of their rights to do so. The complaints records were checked as part of the inspection. A complaint was received from a service user in May. It was difficult to establish from the records how the complaint was fully investigated and what the outcome from this complaint was. The complaints records must be improved to provide details of any investigations and action taken and the outcome of the complaints. A copy of the society’s policy on physical intervention and restraint has been reviewed and a copy is available in the home. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,27,28,30 The home’s environment has been enhanced since the last inspection and now provides a comfortable, safe and homely environment. The home is well located, close to shops and transport links and is suitable for it stated purpose. Bathrooms are bright and clean and there are sufficient shared spaces. The carpet in the main lounge is stained and it needs to be deep cleaned regularly. EVIDENCE: The home is purpose built with wheelchair access. There is an entry phone system fitted to the main front door. CCTV cameras have been installed to monitor the main entrance only. The home is well located, close to shops and transport links and provides a comfortable, safe and homely environment. A tour of the communal areas was undertaken. Major building work has been completed to rectify the cause of water damage in the flat and a new suspended ceiling has been put in place. A new carpet has also been fitted in the main hallway. Bathrooms are bright and clean and there are sufficient shared spaces. The carpet in the main lounge is stained and it needs to be deep cleaned regularly. There is a separate laundry room equipped with two washing machines and two dryers. The home was clean and hygienic at the time of the inspection. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 & 35 There is a full and permanent staff team employed at the home, which has resulted in service users benefiting from receiving care from a familiar staff team. Although induction training is offered to new staff, some staff have not received training since May 2003 and not up-to—date with training in safe working practices. This is crucial for ensuring that service users’ needs are understood and their health and safety is promoted. Pre-employment checks are completed by the society’s human resources team. The Manager must received written confirmation that the pre-employment checks, which include references and CRB and POVA checks have been completed and are satisfactory prior to staff commencing employment. EVIDENCE: Since the last inspection, the Manager and staff confirmed that the home has successfully recruited support workers to complete the team. This has resulted in six full time permanent members of staff being employed at the home. The Manager and staff confirmed that this continuation in the staff team has had a positive effect on the wellbeing of the service users. On the day of the inspection, three of the staff team were attending training in learning disability awareness. The Manager confirmed that staff who recently commenced employment, have completed their induction training. The training records of all staff were checked. According to the records, two staff members had not received any training since May 2003. One staff member did FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 17 not have a training record. It was also unclear if staff were up to date with their training in safe working practices. The training records must be kept upto-date. The Society’s human resources department is responsible for ensuring that all pre-employment checks have been completed prior to staff commencing work. Currently, the Manager does not received confirmation in writing that the preemployment checks, which include references and CRB and POVA checks have been completed and are satisfactory and so an immediate requirement was left to ensure that confirmation in writing is obtained by the manager. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Staff need to be up-to-date with their training in safe working practices to ensure that the health and safety of service users are promoted and protected. Health and safety documentation on the whole was well completed. EVIDENCE: Health and safety documentation was checked as part of the inspection. Fire alarms are tested weekly as per the regulations and water temperatures are also tested and recorded weekly. There was evidence in the maintenance book that the fire equipment have been recently tested and that the last fire drill took place on the 3rd of June 2005. Portable electrical equipment were tested in June and other equipment such as the parker bath was also serviced recently. Any faulty equipment and or any problems with the building are reported promptly. As previously discussed in this report, staff are not up to date with their training in safe working practices and they must be in order to promote and protect the health and safety of the service users. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x 3 x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 2 x 3 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x 3 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 FLAT 4, 22/24 GREAT WESTERN ROAD Score 3 2 2 2 Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 20 yes 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 1 Regulation 4 Sch 1 Requirement The statement of purpose must to be updated to include details of the current manager. The original timescale of 1st December 2004 was not met and is this requirement is being repeated for the second time The Manager must ensure that the individual plans are reviewed formally at least annually with the input of the service user and representatives where apprioriate. Risk assessments must be regularly reviewed to reflect the changing needs of service users.This requirement is being repeated for the second time. The Manager must ensure that the service users are offered a minimum annual health check including optical and dental checks. This requirement is being repeated for the second time. The Manager must ensure that when the code F is used, the reason why the medication was not administered should be defined on the MAR sheet. Service users’ wishes regarding Timescale for action 31st August 2005 2. 6 14 & 15 31st August 2005 3. 9 13(4) 31st August 2005 31st August 2005 4. 19 13(1b) 5. 20 13(2) 31st August 2005 1st Page 21 6. 21 12(2&3) FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 7. 22 22 8. 9. 28 35 23 18(1-4) 10. 35 18 11. 34 19 12. 35 13(3-6) 13. 42 13(3-6) death and terminal care must be considered and confirmed. This requirement is being repeated for the second time. The complaints records must be improved. to provide details of any investigations and action taken and the outcome of the complaints. The carpet in the main lounge is stained and it needs to be deep cleaned regularly. The Manager must ensure that staff receive at least five paid training and development days per year. Staff individual training and devleopment assessment and profile must be updated so that it fully reflects the training attended and their training needs. This requirement is being repeated for the second time. The Manager must receive confirmation in writing that the pre-employment checks, which include references and CRB and POVA checks have been completed and are satisfactory prior to staff commencing employment. Staff must be up-to-date with their training in safe working practices including infection control, fire, health and safety, food hygiene and manual handling. As above October 2005 1st October 2005 31st August 2005 1st October 2005 31st August 2005 19th July 2005 1st October 2005 1st October 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 22 No. 1. 2. Refer to Standard 6 41 Good Practice Recommendations Consideration should be given to find ways of making the ISP’s available in a format that service users can understand. This recommendation is being repeated. A computer should be made available for staff use in Flat 4. FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26/28 Hammersmith Grove London W6 7SE 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 FLAT 4, 22/24 GREAT WESTERN ROAD G09 - G60 S10878 GREAT WESTERN ROAD (FLAT 4) AIV231913 120705 STAGE 4.doc Version 1.40 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!