Inspection on 25/07/05 for Hawthorn House

This inspection was carried out on 25th July 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

Hawthorn House 12/11/08

Hawthorn House 18/12/06

Hawthorn House 06/02/06

Hawthorn House 05/01/05

Hawthorn House 02/09/04

Hawthorn House 10/03/04

Similar services:

Polesworth Group 68 Long Street

10 Whitfield Avenue

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hawthorne House Burton Old Road West Lichfield Staffordshire WS13 6EN Lead Inspector Wendy Grainger Announced 25 July 2005 9:00am 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. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hawthorne House Address Burton Old Road West Lichfield Stafffordshire WS13 6En 01543 252211 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) Staffordshire County Council, Social Care and Health Directorate Suzanne Morris CRH 29 Category(ies) of DE - 10 registration, with number DE(E) - 10 of places LD - 29 LD(E) - 15 MD - 4 MD(E) - 4 PD - 20 Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 15 January 2005 Brief Description of the Service: Hawthorn House is a Local Authority home within a residential area of Lichfield and provides long-term care and support for twenty nine adults with a learning, physical disability and more complex needs including sensory disabilities, challenging behaviours and mental health issues. The home consists of two buildings, both purpose built and provided care within four separate units. Upper and Lower Hollies provide twelve bedrooms and Upper and Lower Rowans provide sixteen bedrooms. Both units have a ground and first floor. Each unit consists of three communal lounge/dining areas kitchen or basic kitchen facility, bathroom, shower room and each individual had a single room. There is an industrial kitchen and laundry room in each building. In Upper Rowans, the unit has a small flat where service users are supported to live semi-independently. Lower Hollies provides a six bedded special care unit for service users with more profound disability problems.Service users have access to Lichfield Day Services. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was completed on the 25 July 2005 the registered care manager, management, staff and residents assisted in the completion of the report. Records, reports and documents as required were provided. Observations of the staff on duty and the care practices and interaction were part of the inspection. Feedback was given at the end of the inspection. Located in a quiet road near to the centre of the town of Lichfield. Both homes were inspected during the day. Each unit provided care for various dependencies of people with a learning disability. Each of the units were visited during the inspection. Both houses were self contained and provided the required facilities i.e. bedrooms, kitchens, lounges, bathing and toilet facilities. The lower house was the main office/administration area. Sufficient parking space and large garden patio areas were evidenced. At the time of the inspection the home had one vacancy for a resident and one soon to be vacancy when one resident moves into the Community. The Commission had received seven comment cards; three of the residents had provided comments each of them had no concerns regarding the care they received. Four relatives responded, three with additional comments; “ my sister is very happy at the home. All the staff are very helpful in every way. I couldn’t wish for a better home for her” “ I am extremely pleased with aspects of care given to my daughter, staff are always very professional, kind, caring and informative thank you everyone” “I am very happy with the standard of care for my sister”. “The only concern I have is that the home remains owned by Staffordshire County Council and the promising young members of the staff will be encouraged to stay to provide continuous care when long serving staff retire. I feel that it is important for residents to be cared for by familiar trusted faces.” The Service Users Guide had been reviewed and the issues raised regarding costs incurred by the residents and not included in the basic contracts were to be included in the new contracts and documents. Pre assessments were part of the required practice and continued. At the time of the inspection the registered care manager with other contemperies were undertaking an assessment to fill the vacancy. This person had visited the home and will be invited for an overnight and weekend stay. Personal plans for the daily and long term care of each resident were collated following an admission and as an ongoing practice. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 6 Arrangements were in place for each resident to receive personal and health care from other professionals. The residents accessed the community for health needs when possible. At the time of the inspection one resident was receiving regular visits from a district nurse to monitor her present health condition. This resident was observed during the inspection and found to be comfortable; all records were current to her daily needs. Each of the residents had access to the day service in the area. Meals at the home would be arranged for the residents that attended the day service around the menus provided by the centre. A lighter meal would be prepared for the evening. The menus evidenced today provided a choice and balanced diet. The environment in both homes was exceptionally good in their hygiene, and the staff should be congratulated. There were areas that had been identified, as requiring decoration these were not extensive in respect of the bedrooms. At the time of the inspection the large lounge in the upper house was being decorated. Within the plan of care each resident was made aware of the process to make a complaint. This and the required documents would enable families and visitors to raise concerns. The management had robust and appropriate systems in place when recruiting and employing new staff. The on going training programme was current and further training had been identified and planned for. This information was evidenced from the records provided. Management and the care staff provided comfortable and well maintained environment. The consideration for the health and safety of residents was a priority at all times. What the service does well: The management and the staff provided a homely environment, which was comfortable and exceptionally good in its hygiene. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 7 Committed staff on duty were observed to continue with their daily routines working together to provide quality care; meeting the needs of a varied client group, some with complex needs. There was a record of close working with health care professionals, promoting a pro-active approach to care. Discussions with the staff confirmed that training needs were met and more training was planned for 2005. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,4,5 The home had good procedures in place to ensure prospective residents were properly assessed before admission. EVIDENCE: At the time of the inspection a prospective resident was being assessed to live at Hawthorn House; the registered care manager and contemperies in other agencies were undertaking this assessment. The person will be invited for an over night stay followed by a weekend stay, there was no limit to the number of visits or stays. Each of the residents were provided with the terms and conditions of the home. The recently reviewed contracts and Service Users Guide will include the actual costs expected of the County. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 10 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 homes systems and routines for maintaining documents in respect of the physical and health needs were well maintained, current and informative. EVIDENCE: Samples of the care plans were seen during the inspection. The inspector was impressed with the registered care manager’s action to streamline one care plan in particular. The resident now required full care due to age and medical condition. Her plan was informative current and clearly identified her needs. The staff and other professional agencies were providing all care. A small number of the residents had no verbal communication; other methods were used including flash cards. The speech therapist was involved in the care of a number of the residents. There was evidence of generic and individual risk assessments. Residents were supported in their life style by knowledgeable caring staff. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 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) 12,13,14,15,16,17, Residents were free to attend local cultural and appropriate facilities within the community. They were enabled to express their choice of friends and maintained links with families. The food provision to was good. Appropriate conditions were provided when preparing the food. EVIDENCE: A number of the residents chose to go to the Day Service based in Lichfield; from here some go to college on a day release. No resident at Hawthorn was employed in a full time occupation with the exception of one gentleman who has a small wage as part of a gardening project at the Day Centre. Residents were part of the community and attended the local church, shopping, public houses, lunches out with staff. The nearest cinema is in Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 12 Tamworth and accessed by residents. The home did not experience any animosity from the neighbours. The County Council residents survey for a number of residents had been completed with the co-operation of families. Links were maintained with the relatives and friends on a regular basis. Where no families were identified residents were befriended; by some one they had known for a long period of time. Menus from the Day Centre were provided to ensure a well balanced diet for residents that attended. One of the residents was prepared a soft diet the inspector was satisfies after speaking to the cook that it was presented in an attractive manner. The inspector observed lunch with the companionship of the staff sitting at the table during lunch. Dieticians were available and had provided a thickener for food and drinks for one person. Specialist diets i.e. glutton free were catered for. It was recommended that all the food should be dated when placed in the freezers. It was advisable to retain the food in the original packages. Two residents did have a close friendly relationship and spent time in the lounges together. This was fully documented and staff made aware. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 13 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) 18,19,20,21. Resident’s lifestyles, and the support they required were well documented. Residents had unrestricted access to all primary and specialist health care facilities. The policies and procedures for the handling of medicines, coupled with the training provided ensured that the system was safe and satisfactory. EVIDENCE: Care plans evidenced that individuals had different needs, the residents spoken with at the time of the inspection confirmed that they were well cared for and that they did not object to either of the two male cares on duty. Each resident had a key worker to assist them. During the time spent in the top house there was a lively banter between the staff and two residents. There were no constraints on the life style of the residents; with the exception that people attending the Day Centre had to rise in time to access the transport. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 14 One resident retained control of his medication. Arrangements had been made via the general practitioner for one resident to receive medication in a liquid form. Staff had received training in the safe handling of medicines. The registered care manager was to commence a distance learning course for medication in September 2005. Each resident had access to specialist and local physician intervention. One general practitioner arranged regular six monthly or annual reviews for residents health and medication needs. The inspector evidenced the care provided for one resident who was receiving full care. The bedroom was warm but well ventilated; she was comfortable in a reclining chair. All care and attention was provided. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 15 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. Residents were provided with clear information on how to make a complaint. The training provided ensured that the residents were protected as far as possible from abuse. EVIDENCE: Evidenced in the care plans identified that each person had access to the complaints procedure suitable to their ability. Visitors to the home had access to the appropriate information from the documents displayed. The Commission for Social Care Inspection had received no complaints about the service provided. From the evidence in the sampled care plans, residents were aware who to speak to in the event of them having a complaint. All the staff received training for the safe keeping and protecting residents from abuse. This was evidenced from the training matrix used by management and confirmed by the staff spoken with. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 16 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) 24,25,26,27,28,30 The high standard within both homes provided residents with an attractive, safe, comfortable, homely environment to live in. Systems in place ensured residents were protected against the spread of infection. EVIDENCE: Both houses were inspected; bedrooms and bathing facilities were sample viewed. The lower house had had extensive refurbishment. The registered care manager recognises that the top house will be the next area for refurbishment. This had commenced as part of the rolling programme for maintenance and decoration; with the decoration of the main lounge. Both homes were exceptional in their hygiene, staff worked as a team to maintained the standard. A selection of bathing facilities suitable to meet the needs of individuals were evidenced, specialist equipment had been provided where appropriate. Bedrooms were individualised to suit resident’s personal tastes. Two residents took the inspector to see their very pretty colourful bedrooms. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 17 Many of the bedrooms seen had been fitted with furniture chosen by the residents with the agreement of families. Lounges in both homes were well maintained. There were further plans to rethink the style of one small lounge in the top house. All the areas were warm, comfortable, and fully accessed by the residents within the safe environment. The specialist equipment provided individually and collectively were maintained twice yearly. The inspection identified that staff were aware of the systems in place to control the spread of infection. Alginate bags, COSHH information, paper towels, gloves and aprons were evidenced throughout both houses. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 18 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) 32,33,34,35,36 Staffing levels were appropriate to meet the needs of the current resident group. The skill mix benefited the life style of the residents. The home had in place systems and checks when recruiting staff that protected the vulnerable residents. EVIDENCE: The inspector was satisfied that all the required documents were provided for the employment of new staff. I.e. contracts, job descriptions, code of conduct. At the time of this inspection there were forty-one staff employed at Hawthorn House. Each person undertakes an induction programme; followed by the National Occupational Standards Award in Care and foundation course. Ten of the staff had achieved NVQ in Care level II; two more were working towards completion of the qualification. Three staff had level III NVQ in Care a further two were working towards the qualification. Staff spoken with confirmed training that was mandatory and other courses available to them to ensure the best care for the residents. The home had a robust recruitment process that complied with the National Minimum Standards. No staffs were employed until the required Criminal Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 19 Record Bureau checks had been received, two references had been checked, and the person would then be expected to attend an interview. The inspector spent time in the houses, observing the residents and staffs interaction, which was pleasant and helpful when required. The interaction was respectful and residents responded to the staff who were committed to the residents and home. Life carried on as normal during the day, it was a pleasure to be part of the experience. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 20 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) 37,38,40,41,42, From the evidence gathered, and observations made during the day, it was obvious that Hawthorn House was operated in the best possible manner to benefit the residents and safe guard their interests. EVIDENCE: The registered care manger had retuned from maternity leave. She had been employed by the County for many years; her experience had been gained as a care manager in a home north of the County within Staffordshire. Because of her maternity leave she is to undertake Level IV NVQ in Management and the Registered Managers Award later in the year. Her qualifications included D32/33 NVQ III in Care NEBBS. She is also a verifier for NVQ. Responsible for both houses, she maintained a daily contact with each unit. Not on the working rota, she was fully aware of the operation of the homes because of the shift patterns she works; and would be hands on if necessary. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 21 During the inspection it was obvious that the manager created and open relaxed atmosphere. The staff confirmed that they felt well supported by her and the residents responded to her with warmth and affection. The inspector was impressed with the documentation the County were to operate to seek the views of the residents. Feed back from the residents meetings evidenced during the inspection, identified views were sought of the service provided. The continuous audit of the service and home ensured that any defects to the building were rectified and concerns addressed. Staff when spoken with confirmed that hey had been part of the mandatory training programme plus any training relevant to their roles and responsibilities. Regular supervision was confirmed from the records and verbal confirmation of the staff. The inspection identified that the required weekly/monthly/annual checks on the fire system was satisfactory. The only recommendation the inspector would make was that staff signed personally when they had been part of a fire drill. The records evidenced that the required servicing of equipment was current. Eight of the staff had First Aid training the senior management had received training in the administration of rectal diazepam. The home was a viable business; insurance cover was current and available. The registered care manger with the administration staff operated the homes budget. Finances for the residents were checked at random. The system used was robust and protected the residents from financial abuse. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 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 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 x 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 4 4 3 3 3 4 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hawthorne House Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 4 3 x 3 3 3 3 E51-E09 S30294 Hawthorne Hse V235447 25.07.05 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 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. Refer to Standard 17 43 Good Practice Recommendations To date all the food stored in the freezer and to maintain the food in the original packages. For the staff involved in a fire drill to sign the records personally. Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Hawthorne House E51-E09 S30294 Hawthorne Hse V235447 25.07.05 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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