Inspection on 16/04/07 for Healey House

This inspection was carried out on 16th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Healey House 16/01/06

Healey House 04/07/05

Healey House 05/11/04

Healey House 23/09/04

Healey House 09/02/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Healey House 1 Oakenshaw Avenue Healey Whitworth Lancashire OL12 8ST Lead Inspector Mrs Christine Mulcahy Unannounced Inspection 16th April 2007 10:30 Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Healey House Address 1 Oakenshaw Avenue Healey Whitworth Lancashire OL12 8ST 01706 759692 01706 759692 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Anna Geraldine Ellis Miss Marie-Louise Bennion Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should employ a suitably qualified and experienced manager who is registered with the Commission Date of last inspection Brief Description of the Service: Healey House is registered with the Commission for Social Care Inspection to provide care and accommodation to eight younger adults who have a learning disability. Healey House is situated close to the boundary that divides Rossendale and Rochdale. The home is situated on a main bus route and residents can use public transport with staff support. Transport provided by Healey House is also available for residents to access facilities in both areas. The home is an end terraced Victorian building that provides homely spacious accommodation on two levels. Access to the first floor is via a passenger lift. The first and second floor can be accessed via a staircase. There are large single bedrooms, bathing and toilet facilities on the ground and first floor. The ground floor consists of two lounges a dining area and a kitchen. Confidential information and medication are both stored securely in separate rooms. The home is decorated, equipped and furnished to a good standard. Furnishings are domestic in character. There are enclosed garden areas surrounding the property. Prospective residents can have a copy of the statement of purpose and a service user guide. Fees at the home start from £1000 per week but are subject to change depending on service user need. Additional charges are made for clothing, hairdressing, toiletries, holiday spending, meals out, admission to places of interest and gifts for families. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, including a visit to the home, was carried out on 16th March 2007. Information was obtained from care plans, records, management systems, relative questionnaires and care observations. The inspector also spoke to 6 residents, 2 staff and the registered manager. What the service does well: What has improved since the last inspection? Since the last inspection the home has continued with the schedule of planned work. The kitchen, upstairs bathroom, and one bedroom have been completely refurbished. This work has ensured there are sufficient numbers of lavatories, wash-basins, toilets and showers at appropriate places for the people who use the service. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 6 The duty staff rota is no longer shared with another home within Healey Care. There is now a separate duty rota for Healey House that includes people working in that home and the actual hours worked. This means that the ratios of care staff can be clearly determined and the system operated applies only to Healy House. The majority of policies and procedures have been reviewed and updated. This means that safe working practices ensure the safety and welfare of the staff and people who use the service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Healey House DS0000009602.V332228.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): YA 1 & 2 Quality in this outcome is excellent. This judgement has been made using available evidence including a visit to this service. People who may use this service and their relatives have the information needed to choose a home that will meet their needs. EVIDENCE: The home had developed a comprehensive statement of purpose and service user guide. Both documents are specific to the resident s that live there and sets out the objectives and philosophy of the service. The service user guide shows what people who use the service can expect and clearly explains the specialist services provided, quality of the accommodation, qualifications and experience of the staff, how to make a complaint and CSCI inspection findings. People who already use the service have been involved in the process and have given their comments and experiences of living at the home. There are photographs of residents in the documents and they have helped to design the layout of the information. Copies of these documents are made available in formats that meet the capacity of the resident. Case tracking confirmed that a new resident had received a full comprehensive needs assessment before moving into the home. Skilled workers through care management arrangements carried this out and a copy of this was obtained before the resident’s admission. The assessment focussed on achieving positive outcomes including ensuring the staff and specialist services meet the Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 9 resident’s individual ethnicity and diversity needs. This person was given time to spend in the home before moving in. There was a contract agreed by the resident’s relatives. The contract gave clear information about fees and charges and the registered manager said this would be reviewed periodically and kept up to date. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): YA 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s needs were set out in a plan of care to help them maximise autonomy and choice. Health and safety procedures ensured residents were involved in decisions about their lives and wellbeing. EVIDENCE: The case tracking of one resident confirmed that he had a plan of care that included sufficient details for staff to meet his identified needs The care plan examined showed that the resident had undergone a thorough review and staff were fully committed in supporting him to lead a purposeful and fulfilling life as independently as possible. The plan includes photo’s, pictures and is written in plain language. It is a comprehensive up to date working tool used by the staff team, relatives, professionals and the resident where appropriate. It can be used easily and quickly by new staff who are not familiar with the resident so there is continuity in delivering a personalised quality service. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 11 The resident’s relatives, the resident and professional workers, developed the care plan and it sets out how the resident’s requirements and aspirations are to be met through positive support. The care plan is person centred and includes comprehensive risk assessments for health and daily living and this is regularly reviewed. So that the resident and his family can contribute in the development of his care plan there is an ongoing review process. Staff have the specialised training and skills to support, engage and encourage the individual to be fully involved. A key worker was observed actively providing one to one support and communicating the resident’s needs and wishes to others on his behalf. The good practice of addressing religious, cultural and relationship needs in a care plan was noted. There was an excellent example of how the home would meet the specific communication needs of a resident whose first language wasn’t English. Staff were aware of the first language used by the service user and there was a directory of words and phrases that staff must use when speaking to the resident. This means there was recognition amongst the staff of the diverse needs of the people who use the service and strategies to meet these needs were in place. People who use the service are continually consulted about the running of the service and are able to influence key decisions in the home. There are regular resident meetings held as a forum for decision making about the day-to-day life of the home. Notes are taken and these were examined showing that the home acts on the results of the meetings with the people who use the service. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): YA 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Leisure and recreational activities available met the social needs and interests of the people who live there. Visiting from relatives and friends is flexible. Meals and snacks ensured variety and nutrition. EVIDENCE: The philosophy of the home strongly promotes the resident’s right to live an ordinary and meaningful life both in the home and in the community. The registered manager said that wherever possible residents were able to make choices about aspects of their lives like waking and going to bed times and handling their own finances. There was a strong commitment to enabling resident’s to integrate into community life and use facilities that develop their Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 13 skills like day centres, work experience, art classes, swimming and bowling. This was done through a person centred approach. Discussion with residents and observation confirmed that as far as possible their independence was maintained. When asked about the variety of activities available at the home one resident said that he enjoyed going to the art group and on his return happily told the inspector about his visit there. There were a number of pictures around the home painted by one of the resident’s and the inspector observed a member of staff patiently supporting a resident while he used the art materials to complete a self portrait. Another resident was out at work achieving a city and Guilds in catering. Where appropriate education opportunities were encouraged and accessing facilities like the library, public transport, shops, supermarkets and pubs in the local community were popular activities. The service actively supports people who use the service to be independent and involved in all daily living activities in and around the home. It was apparent that routines are flexible to help residents make informed choices in areas of their lives and daily living. The menu and times and times at which meals are served is varied to suit the requirements of the people who use the service. Meals seen were well balanced and nutritional with a number of choices that caters for the cultural and dietary needs of the people who use the service. When asked about the menu and meals at the home one resident told the inspector that take away food and eating out were always a part of the menu and this was always chosen by the residents. “We sometimes go food shopping as well”. He said. Resident’s religious and cultural needs had been assessed and identified on moving into the home as part of the admission process. Where these had changed the registered manager said staff would be sensitive to these changing needs and support the resident’s in their decisions. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): YA 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health care needs were set out in a plan of care. Residents were protected by the homes medicine policies and procedures. Care practices observed showed resident’s privacy and dignity was respected. EVIDENCE: Case tracking confirmed that all resident’s had a plan of care that included sufficient health care details for staff to meet the identified needs. Resident’s health needs were identified and reviewed regularly and access to health professionals was given. Evidence of contact with other services like GP and Optician were clearly recorded and kept in the service user care plan. There is an efficient medication policy supported by procedures and practices that staff understand and follow. Examination of the medicines trolley and MAR sheets showed that medication was stored and managed appropriately. Medicine records were fully completed and signed by the appropriate staff. The registered manager is vigilant in this area and regularly checks to monitor compliance. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 15 There is a good record of compliance with the receipt, administration and safekeeping of medicines and over half of the staff team have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. This was confirmed through discussion with a staff who was able to give a clear account of her role when administering medication. She had also received specialist training to administer Valium to resident’s who had severe epilepsy. The registered manager was reminded to retain a signed receipt from the supplying pharmacist as proof of medication returned. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): YA 22 & 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Complaints made by residents and relatives were acted on and recorded. Residents are protected from abuse and have their rights protected. EVIDENCE: There is an open culture at the home allowing residents to express their views and concerns in a safe and understanding environment. One resident was asked if he knew who to go to if he had a complaint or a worry and replied, “I’d go to Marie I’d tell her”. There is a complaints procedure that is clearly written, easy to understand and is available in different formats like large print. People who use the service are given a copy of the complaints procedure along with a service user guide and copies of the complaints procedure can be made available on request. The registered manager said that residents know that problems will be dealt with immediately before they become complaints and it was important to do this because people live in close proximity and share facilities. She said, “Residents know that problems will be treated seriously and quickly so that the environment in the home isn’t affected”. The complaints book was examined and the registered manager confirmed that no complaints had been made since the last inspection. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 17 There is a robust policy and procedure for Safeguarding Adults and gives clear guidance to those using them. More than half of the staff team are trained in Safeguarding Adults and the registered manager said that the remaining staff would be trained in this area within the coming months. Other training around dealing with physical and verbal aggression is also made available to staff when needed. One member of staff when asked about the policy and procedure was fully aware of where to find the policy and how it should be used. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): YA 22 & 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of decoration and furnishings in the home ensured the environment more comfortable and homely. The home was clean, pleasant and hygienic. EVIDENCE: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the people who live there. Residents are encouraged to personalise their bedrooms with new soft furnishings chosen by them and are encouraged to see the home as their own. It is very well maintained, decorated and furnished to a high standard. The current environment is fully able to meet the changing needs of residents and is designed to provide small group or cluster living where residents can enjoy maximum freedom in a non-institutional setting. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 19 Some areas of the home like the kitchen, upstairs bathroom and one bedroom have been re decorated and refurbished. Residents said they were involved in choosing the colour scheme of the bathroom and furnishings and carpet throughout the home. All residents have a single room and all of these are above average size, well designed and in close proximity to bathrooms and toilets. Fixtures and fittings are of high quality, well maintained and adapted to meet the needs of current occupants. There is an emergency call system for residents who might require assistance and a passenger lift for access to the first floor. The home was well lit, very clean and tidy and smelled fresh. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 20 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA 32, 34 & 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff are trained, skilled and in sufficient numbers to support the residents and the smooth running of the service. EVIDENCE: The staff rota showed the home was staffed sufficiently. Particular attention was given to busy times of the day and specific needs of residents like medical appointments, educational or leisure interests and at peak times of activity. The inspector observed staff involved in a number of activities with residents demonstrating there were enough staff available to meet residents needs. A copy of the training matrix was examined and showed staff training was ongoing. The registered manager encourages staff to undertake external qualifications beyond the basic requirements and this is focused on delivering improved outcomes for people using the service. All staff hold a current first aid certificate and 54 of care staff have NVQ level 2 or above. There is a good recruitment procedure that clearly defines the process to be followed and ensures the protection of resident. People who use the service are Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 21 regularly involved in the recruitment of staff and their views are considered within the selection process. There is a wide diversity within the staff team that reflects the culture and gender of people using the service. Staff were observed communicating effectively with residents demonstrating a wide variety of skills used to ensure residents needs are met properly. Staff case tracking and discussion with a staff member confirmed pre employment checks required to ensure the protection of residents were done. Staff meetings take place regularly as do supervision sessions and, when asked, a member of staff said she found them helpful. The staff file was examined and relevant records were kept. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 22 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA 37, 39 & 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. The systems in place ensure the home is comfortable with flexible routines that safeguard the people who live there. EVIDENCE: The registered manager has the required qualifications and experience and is competent to run the home. She has a clear understanding of the key principles and focus of the service. She is person centred in her approach and is aware of current developments and can plan the service accordingly. The home has the necessary insurance cover in place to fulfil any loss or legal liabilities. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 23 There were details and records kept of residents charged and paid. Records of residents finances was examined and staff signatures verified the transaction. Many of the homes policies and procedures including the health and safety policy have been reviewed to ensure safe working practices. Records and documents showed appliance, equipment and safety checks were done regularly. Staff are trained and know how to follow these. Good practices, monitoring and record keeping ensure there is a very low number of preventable accidents and the manager complies with statutory reporting requirements and other relevant legislation. Record keeping was of a consistently high standard and records are kept securely. An internal audit is carried out to determine service user and their relatives satisfaction. The survey outcome was not available although completed service user questionnaires were seen at inspection and outcomes were positive. The manager and staff have a good understanding of the risk assessment process and this is taken into account in all aspects of the running of the home. The manager ensures that all staff are trained in health and safety matters. Training records examined reflect this and regular updates are planned. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 X 4 X 3 X X 3 X Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations It would be consideded good practice for the registered manager to ensure there is a receipt signed by the pharmacist to verify the return of medicines. Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Healey House DS0000009602.V332228.R01.S.doc Version 5.2 Page 27 - 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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