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Inspection on 20/09/05 for Heath House Care Centre

Also see our care home review for Heath House Care Centre for more information

This inspection was carried out on 20th September 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents are fully assessed, which includes a visit by the staff from the home, gathering multi-agency information, completing assessments of need and then writing initial care plans. There is a well planned and a wide variety of entertainment and activities, this is planned by an activity co-ordinator in consultation with residents and their representatives. The managers are very focussed on the health and safety needs of residents, they have implemented protection plans in consultation with other agencies including Birmingham Social Care and Health.

What has improved since the last inspection?

Medication practices have further improved to provide a safer system for the residents. Recording of information specifically in respect of community healthcare services has improved and is more easily accessible.

What the care home could do better:

Further improvements are needed within the care planning process and risk assessments for residents. The laundry service must be improved to ensure that residents are provided with a good service. Furniture including special chairs where heavily damaged must be replaced and outstanding work including providing suited locks on all residents rooms must be completed. The registered person has produced an action plan to address the required improvements in a timely fashion.

CARE HOMES FOR OLDER PEOPLE Heath House Care Centre 81 Walkers Heath Road Kings Norton Birmingham West Midlands B38 0AN Lead Inspector Sean Devine Unannounced Inspection 20th September 2005 09:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Heath House Care Centre Address 81 Walkers Heath Road Kings Norton Birmingham West Midlands B38 0AN 0121 459 1430 0121 486 1728 heath.house@ashbourne.co.uk 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) Exceler Healthcare Services Limited Gillian Pratt Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (50), Old age, not falling within any other category (50) Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service user categories; dementia over 65, Mental disorder, over 65, care with nursing, 50 places Within the 50 places, the home may accommodate 10 named service users under the age of 65 at time of admission. 10th May 2005 Date of last inspection Brief Description of the Service: Heath House offers nursing care for up to 50 older adults with mental health needs. This includes both dementia and those with longer-term psychiatric diagnoses. There is a skill mix in the qualified nursing staff, but they are predominantly RMNs. The premises is a conversion and extension of an existing property and is situated to the south of Birmingham. It is located close to public transport links. The building is divided into two units, “Heathside” and “Walkers Lodge”. There is adequate car parking facilities to the front of the premises and an enclosed garden area to the sides and rear. Accommodation is a mixture of single and shared rooms. All bathing facilities are shared, although some bedrooms have en-suite toilets. There are communal dining areas and lounges on the ground floor, together with the kitchen, offices and laundry, smoking area and some bedrooms. The first floor consists of bedrooms and bathing/toilet facilities but has no communal space. It is accessed by stairs or shaft lift. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is inspection was conducted on an unannounced basis by two regulation inspectors, over a period of one day. Prior to the inspection the CSCI had received a complaint, which was investigated at the time of inspection. Details of the complaint, investigation findings and required actions are detailed in the main body of the report. Three elements to the complaint were upheld. Improvements must be undertaken to address concerns in respect of manual handling, managing odours and ensuring residents clothing is adequately laundered. The inspectors were able meet many residents and staff, including more formal interviews with staff, view records pertaining to care provision and service delivery. A tour of the home including communal areas and residents’ private rooms was undertaken. The home has addressed many of the requirements from the last inspection, those carried forward are being addressed but this has taken more time due to the need for financial and organisational support; such as with repairs and with the printing of the new statement of purpose and residents guide. What the service does well: What has improved since the last inspection? Medication practices have further improved to provide a safer system for the residents. Recording of information specifically in respect of community healthcare services has improved and is more easily accessible. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 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. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,4,6 Information is gathered to allow the manager to make an informed choice as to whether the home is suitable to meet the residents’ needs, there is not adequate information available for residents to do this. EVIDENCE: The manager advised the inspector that the statement of purpose and residents guide remain with the printers and are not available at the home. This has been raised as a matter of concern at the past two inspections. The home must ensure information as detailed in the Care Home Regulations 2001, regulation 4 and 5 is available to prospective residents and their representatives. All prospective residents are assessed by the home prior to any admission. These assessments are often undertaken in hospitals. Details of these assessments and information such as care plans from social workers, care programming approach reviews and nursing determination assessments were available and gathered prior to admission. Some of the information provided by these other agencies was limited and not altogether current. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 9 The residents are mainly from White-European backgrounds, however some residents are from an Afro-Caribbean background and this is reflected in the staff compliment. Many of the staff (care and nursing) have been employed a long time and have developed skills and experience in supporting residents with a dementia. Intermediate care is not a service offered by the home. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. The health and care needs including risk management to residents are met, some improvements are needed to ensure this is managed safely and effectively and which identifies to staff all the care needs of residents. EVIDENCE: The complainant was concerned that a resident had been hurt whilst staff assisted with manual handling, that infectious diseases are not adequately managed, that some residents do not have clean and tidy hair and that staff are not supportive and sensitive to the needs of residents. The complainant was also concerned that clothing was not appropriately laundered and one resident did not always wear their own clothes. Care plans developed from assessment are written where possible in consultation with residents and their representatives. Some care plans contained conflicting information and this must be made clear and one did not describe to staff what they should do when a residents wanders into unauthorised areas such as other residents rooms. As identified at the last inspection the review of care plans does not always say how effective the plan Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 11 has been. The manager is aware that normal day care plans must include details of residents’ oral health care needs. Risks for residents in respect of nutrition, manual handling, falls and their mental health are available, however these risk assessments need to be reviewed following incidents of concern or when the needs of a resident change. Some assessments such as manual handling need to inform staff of specific requirements, such as size of sling and type of hoist, it was unclear that assessors are trained to measure residents for the size of sling needed. Some staff were observed to carry out some inappropriate manual handling manoeuvres and on the basis of this the complaint is upheld. Staff were observed delivering care with dignity, sensitivity and professionally it was clear from interviewing staff they understand the needs of residents and communicate well. This element of the complaint could not be substantiated. Records pertaining to community healthcare services are well maintained and reflect that residents where needed have appointments with Hospitals, GP’s, Social Workers, Practices Nurses, Chiropody, Opticians and Dentists. Recent consultation with the Health Protection nurses and GP have effectively managed infection control issues and ensured residents receive the correct treatment. It transpires that most residents have required hair treatment and whilst accepting that residents’ hair was not always neat and tidy this element of the complaint is not upheld. Safe medication practices continue to improve; as required medicines where needed have a protocol to guide and instruct nursing staff in administration. Amounts of medicines are accurate when balanced against current stock. All creams and ointments are dated when opened and staff have been enrolled onto a training course in respect of the safe handling of medicines. However some practices still need to be improved including not signing for medicines until they have been administered, ensuring dispensing labels on containers are checked before administering and ensuring that all medicines are signed for or appropriately coded on the medication administration records (MAR). The records pertaining to administration of controlled drugs are good however balances must be carried forward onto MAR to ensure amounts tally with the controlled drug register. It was clear that some items of clothing in a chest of drawers and also on hangers in a wardrobe had not been ironed. Several shirts on clothing hangers appear to have been stored after being tumble dried, they had not been ironed. This element of the complaint is upheld. Residents only had their own clothes in wardrobes and chest of drawers, it was apparent that residents were wearing their own clothes and clothing had been clearly labelled. The element of the complaint in respect of residents not wearing individual items of clothing is not upheld. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 and 14 The social and activity needs of residents are met, residents and families are consulted about choices, which means residents needs can be individually planned and their lifestyle fulfilled. EVIDENCE: Initial and ongoing assessments are completed to gather information in respect of social contacts and fulfilling activities. This includes the likes and dislikes of residents. The home has an activities co-ordinator who works closely with residents, families and care staff to gather information about life history of the resident. Activity records include religious observations, entertainment and activity such as reading the daily paper. The notice boards announce events such as bring and buy sales, museum visits, Easter bonnet parades, skittles, games and external entertainers. Residents and their representatives are regularly consulted, they are also given details of external agencies such as CSCI and local authority should they require such support. Many residents have been given the choice to bring personal items of possession into the home and many residents, rooms have been personalised to their individual taste and style. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16. Complaints are managed effectively, concerns are taken seriously and where needed appropriate actions are taken to improve the service to the residents, which in turn improves their quality of life. EVIDENCE: A complaint policy is available and residents and their representatives have raised their concerns using the policy. Records detail, what was the concern and a response to the complainant with subsequent actions to improve the service where needed. There have been two formal complaints to the home in the past 12 months, one has been fully addressed and the second is awaiting a response. The CSCI have received one complaint, this has been investigated and reported upon during this inspection. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 22 and 26. The environment and equipment does not adequately meet the safety and care needs of residents and means there may be times when the health and safety of residents is put at risk. EVIDENCE: The complainant was concerned the home was dirty and that there were issues with the management of odours. The management of odours within the home has been of concern to the manager and has indeed been reported upon at previous inspection visits. At this inspection there was clearly a marked improvement in the management of odour in communal areas and the manager reported the use of new cleaning products. It was evident that measures taken have not fully eradicated the problem and the domestic staff are working with a new cleaning company to further improve odour management. The manager has also planned to replace certain carpets that have been affected by these odours. This element of the Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 15 complaint in relation to effectively managing odours is upheld. Inspectors noted that the floors in some residents’ rooms were sticky. At the time of inspection most areas of the home, communal and in residents rooms were found to be clean, they were not dirty and did not put the health and safety of residents at risk. The element of the complaint in respect of the home being dirty is not upheld. All downstairs corridors have recently been painted in pleasant pastel colours and a plan is in place based upon available budgets to continue improvement work in communal areas of the home. This includes the requirements from the last inspection to repair extraction fan units that are not working and ensuring all residents’ rooms have suited locks. The manager needs to ensure that equipment used to support some residents such as reclining chairs are in adequate condition and fit for purpose. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 29 and 30. Residents are supported by a good compliment of staff who are skilled, knowledgeable and committed to their work. This will ensure that resident’s needs are met in a skilled and professional manner. EVIDENCE: There is an adequate amount of staff on duty, night and day. Including two trained nurses at all times. There is a range of qualified nurses but this is predominantly Registered Mental Nurses. There are eight care assistants on duty during the day and three at night. Residents are supported by additional staff, who plan and co-ordinate activities with residents. Many nursing and care staff have been in post for several years and clearly enjoy the role of supporting residents with a dementia. There is a strong compliment of ancillary staff including laundry, domestic work and cooking. There is also a full-time maintenance operative and a fulltime administrator. The manager advised the inspector of the new form used to record staff Criminal Records Bureau Disclosures (CRB), which are completed for all prospective new staff and allows for the original CRB to be destroyed whilst necessary information is retained. Staff at interview confirmed they have completed mandatory training and recently had training in residents’ welfare, manual handling and managing Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 17 physical aggression. As identified in standard 9 staff practices in respect of manual handling must be reviewed and improved to safely meet the needs of residents. Staff were also able to describe adequate measures they would take to protect the confidentiality of residents and to protect residents from real and potential abuse. Staff handover was observed, which indicated they have a good knowledge of residents needs and also reflected upon their good communication skills. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 and 36. Experienced, well-trained and competent managers, who are supportive to both residents and staff manage this service. This enables the home to progress and to improve services to residents in a skilled and effective manner. EVIDENCE: The management team consists of the general manager who was registered with the commission last year and also a very experience deputy manager, with relevant experience and qualifications. It has been evident throughout the inspection year that both managers are committed to their roles and responsibilities and are keen to ensure that residents are provided with an excellent and safe service. Staff at interview praised the management team for being very supportive. The manager confirmed that clinical updates for trained nursing staff were being planned but as yet had not been commenced. Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X 3 X X X 2 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 X X Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 5(1) Requirement The home must develop a service users / residents guide. Timescale for action 31/12/05 2 OP7 15(2)(b) Previous timescale of 31/12/04 not met, this requirement is carried forward. Residents care plan reviews 31/10/05 must include information about how effective the plan has been. Previous timescale of 31/12/04 not met, this requirement is carried forward. 15(1) 3 OP7 15(1) All care plans must provide staff with upto date information in how to effectively support residents and not conflict with other care plans. Where needs are identified for example, in respect of social activity, expressing sexuality and communication, a plan must be developed to identify how the resident is to be supported. Previous timescale of 31/7/05 not met, this requirement is carried forward. 30/11/05 Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 21 4 OP7 15(1) Normal day care need plans must detail how the oral health care needs of residents will be met. Risk management plans, including falls risk assessments must be updated and reviewed following an incident, for example when a resident falls from bed. Previous timescale of 31/7/05 not met, this requirement is carried forward. Such risk assessments must be informative for staff and include specific information e.g. manual handling assessments must include details of type of hoist and sling sizes. All gaps on medication administration records must be investigated and corrective actions taken. Nurses must not sign medication administration records until medicnes have been administered or otherwise. Nurses must check the dispensing label on blister packs prior to administration of medicines. 30/11/05 5 OP9 13(2) 31/10/05 6 OP10 7 OP21 The stock of medicines for controlled drugs must be carried forward onto each medication administration record. 16(2)(e)(f) The registered person must 15/10/05 ensure that all residents clothing is appropriately laundered including where needed ironed and returned to the resident in such condition. 23(2)(b)(c) The home must repair 31/12/05 extraction fans that are not DS0000024852.V252372.R02.S.doc Version 5.0 Page 22 Heath House Care Centre working. The flooring in the assisted bathroom on Walkers Lodge Unit must be replaced. Previous timescale of 31/12/04 not met, these requirements are carried forward. 23(2)(c) Reclining chairs must be 31/12/05 maintained in an adequate condition and remain fit for purpose. 23(2)(c)(e) All residents rooms must have 31/12/05 appropriately suited locks on the doors Previous timescale of 31/1/05 not met, this requirement is carried forward. 13(3)(4)(c) The registered manager must 16(2)(k) take measures to address the areas of malodour within the home. With specific attention to residents rooms and corridors. Previous timescales of 30/11/04 not met, this requirement is carried forward. The registered person must ensure that adequate infection control measures are taken to reduce and manage offensive odours in the home. The registered person must ensure that all staff are aware of the specific manual handling needs of residents and are fully trained to implement appropriate manual handling techniques. Staff training must include training staff to assess the full manual handling needs of residents. Nursing staff must receive DS0000024852.V252372.R02.S.doc 8 OP22 9 OP24 10 OP26 30/11/05 11 OP30 12(1) 18(1)(c)(i) 30/11/05 12 OP30 18(c)(i) 31/12/05 Page 23 Heath House Care Centre Version 5.0 clinical practice updates. Previous timescale of 30/9/05 not met, this requirement is carried forward. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Heath House Care Centre DS0000024852.V252372.R02.S.doc Version 5.0 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. 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