Inspection on 30/11/06 for Henderson and Harvard

This inspection was carried out on 30th November 2006.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Henderson and Harvard 05/12/05

Henderson and Harvard 21/06/05

Henderson and Harvard 10/11/04

Henderson and Harvard 17/05/04

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Coopers Mill Ltd

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Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Henderson and Harvard Kelvedon Road Tiptree Colchester Essex CO5 0LJ Lead Inspector Ray Finney Key Unannounced Inspection 30th November 2006 09:30 Henderson and Harvard DS0000017845.V324225.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 Henderson and Harvard DS0000017845.V324225.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. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Henderson and Harvard Address Kelvedon Road Tiptree Colchester Essex CO5 0LJ 01621 819235 01621 819354 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) SCOPE Ms Sarah Lyndsey Ashman Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1), Physical disability (8), of places Physical disability over 65 years of age (1) Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability who may also have a physical disability (not to exceed 8 persons) One person, aged 65 years and over, who requires care by reason of a learning disability who may also have a physical disability, whose name was made known to the Commission in March 2003 5th December 2005 2. Date of last inspection Brief Description of the Service: The home consists of two converted semi-detached bungalows, Henderson and Harvard, located in the town of Tiptree. Each bungalow accommodates four service users who are provided with single bedrooms. The home is adapted to meet the needs of service users with physical disabilities. All local facilities and amenities are within easy access. The home has limited parking, which is in the process of being extended and improved. The service users benefit from pleasant gardens and patio areas. The space between the two bungalows has been joined and converted to provide a shared laundry area. Information about the service may be obtained by contacting the manager. The home charges between £780.54 and £1328.96 a week for the service they provide. There are additional charges for personal items such as toiletries, hairdressing and leisure activities; chiropody costs £12.00 and transport £10.00 per month. This information was given to the Commission in September 2006. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to compile this report. The manager provided information in a Pre-inspection Questionnaire. Documentary evidence was examined, such as training records, menus, service users’ care plans and staff files. Completed surveys were received from service users and health care professionals. A visit to the home took place on 30th November 2006; this included a tour of the premises, discussions with service users, members of staff and the manager and observations of interactions between service users and members of staff. On the day of the inspector’s visit the atmosphere in the home was relaxed and welcoming and the inspector was given every assistance from the registered manager, Sarah Ashman, and members of staff. What the service does well: What has improved since the last inspection? The home has made some progress with developing the process of quality assurance with the views of service users, staff and others being sought. Improvements have been made to the environment including a new kitchen sink. Protective coating has been applied to kitchen cupboards to minimise heavy wear and tear caused by wheelchairs. One bedroom has been redecorated. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 6 There is a new call system in place with pads that are easy to use so that service users can call staff if they require assistance. 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. Henderson and Harvard DS0000017845.V324225.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 Henderson and Harvard DS0000017845.V324225.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures service users are admitted on the basis of a full assessment. EVIDENCE: Although there have been no new admissions to the home for some time, there is a process in place for assessing service users’ needs before admission. Discussion with the manager confirms that she has a good awareness of the assessment process. Three service users’ records examined show full assessments of need are in place covering communication needs, daily routines, continence, finances, mobility and self-image. As previously reported assessments are reviewed and changes in needs are reflected in the care plans. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs and goals are reflected in their Individual Plans. Service users are supported to make decisions about their lives and are supported to take risks within the limitations of their capacity to understand. EVIDENCE: A sample of four service users’ care plans that were examined on the day of the inspection visit all contain detailed, comprehensive information. The care plans identified the area of need and ser out aims, actions required to achieve the aim and any other issues that need to be considered. Keyworkers complete a monthly summary review of care plans. There is evidence that care plans are reviewed regularly. Observations of interactions between staff and service users show that staff encourage service users to make choices and take part in the running of the home. On the day of the inspection visit service users were seen to be making Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 10 choices. The manager confirmed that service user meetings are held approximately monthly so that they can discuss their wishes and views on the service. Records show that service users meet regularly with their keyworkers. Care plans examined show evidence of how the manager and staff encourage service users to make decisions and choices. Service users’ records examined show that risk assessments are in place and the care plans relate to the initial assessment of risk. The ‘Risk Assessment and Management Profile’ covers vulnerability, communication, dietary needs, getting up/going to bed, personal hygiene, continence, finance, behaviour, sexual needs, medication, wheelchairs and household safety. Risk assessments examined show evidence of review. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in a range of age, peer and culturally related activities and are part of the local community. Service users are supported to maintain appropriate relationships. The home ensures service users’ rights are protected. Service users are offered a varied and healthy diet that they enjoy, although the environment could be better. EVIDENCE: Service users living in the home are not able to access paid employment because of their complex needs. However, the home supports service users to take part in a range of activities. Service users use local community facilities and are supported to use local shops. One service user spoken with on the day of the inspection visit goes to dance classes and to college once a week for cookery classes. The service user plans to cook something for the home for Christmas. Records examined indicate that another service user attends a Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 12 college computer class. A sample of service user records examined contains details of how service users access community facilities, such as shops, museums and an air show. One service user has been to a Westlife concert. The home ensures family links are maintained and this is well documented in the files that were examined. One service user discussed keeping in touch by email with a relative living abroad. One service user record examined says, “close family contact has been maintained all through my life”. Records also show that another service user has long-weekend visits with relatives. At the previous inspection it was identified that the home does not have a communal area where service users can meet with visitors in private; if privacy is required service users will meet with visitors in their rooms. Future plans are to convert one of the bedrooms when it becomes available into a private lounge. Observations on the day of the inspection visit show that service users are encouraged to be involved in the day-to-day running of the home. Service user records examined contain evidence of helping with food shopping. As previously reported, monthly service user meetings take place. The small size of the home and the domestic nature of the premises ensures that service users individual wishes around meals are taken into account. Discussion with members of staff confirm that individual likes and choices are catered for. Although overall the kitchen and dining areas are kept clean, the flooring in one kitchen has a small amount of damage that has been repaired but is still noticeable. However, the environment would be improved for service users if the flooring is replaced. The dining tables, although solid and safe, need to be rubbed down and re-varnished or repainted to improve their appearance and make the dining experience better for service users. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures service users receive personal support in the way they require and their physical and emotional needs are met. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Care plans examined contain details of the way service users prefer to have personal care carried out. The manager explained the different needs of service users around communication and how service users make their wishes known. Interactions observed during the inspection visit indicate that staff treat service users with dignity and respect. The home operates a key worker system and members of staff are able to demonstrate an awareness of service users’ preferences. Care plans examined show evidence of regular input from district nursing services. Information on specific medical conditions including constipation and epilepsy and how service users are supported with these conditions are well documented. Daily progress records are kept and recording charts for Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 14 monitoring specific health needs. Service user records examined contain details of prescribed medication. As previously reported, all service users are registered with a G.P. at the local medical centre. Consultations with medical professionals visiting the home take place in the privacy of service users’ rooms. Care plans examined contain a “red/amber/green” hospital assessment so that important information is taken to hospital should the service user need to be admitted. This assessment details conditions that must be taken into account for the service user’s health and well-being as well as preferences around healthcare. One service user has specific needs around nutrition and a PEG (Percutaneous Endoscopic Gastronomy) feed is used. The service user’s care plan contains evidence of a recent dietetic report and guidelines for the use of the feed pump. Staff training records indicate that staff receive training relating to service users’ health needs such as the use of a ‘Fresenius pump’. The home operates a monitored dose system for medication. There are currently no service users living in the home with the capacity to self medicate. Medication is stored individually in service user’s bedrooms. Each service user has a secure wall mounted, locked metal cupboard for the storage of their personal medication. Medicine Administration Record (MAR) sheets were examined on the day of the inspection visit and are completed appropriately. Evidence of staff training around medication was examined. Procedures and practices around the administration of medication are good. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident their views are listened to and acted on. Arrangements are in place to help protect service users from abuse, neglect and self-harm. EVIDENCE: The home has a complaints Policy & Procedure in place that contains all the relevant information to meet the National Minimum Standard. Service user records examined contain a copy of SCOPE’s guide to the complaints procedure, which is available in an appropriate format for the service users living in the home. There is suitable documentation in place for recording complaints and a discussion with the manager on the day of the inspection visit demonstrates an awareness of the importance of dealing with and documenting complaints and concerns. As previously reported, service user meetings take place and issues raised are acted on. Records examined show that the home has policies in place for the Protection of Vulnerable Adults (POVA). There is a whistle blowing policy in place so that staff may be assured that they will be protected if they feel the need to raise concerns about practices. As part of the recruitment process, the home carries out POVA checks and Criminal Records Bureau (CRB) enhanced disclosure checks to ensure the protection of service users. Staff training records examined indicate that staff receive POVA training. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall service users live in a homely, comfortable and safe environment, although they would benefit from better bathrooms and showers. Overall available shared spaces are appropriate to meet the needs of service users, although a separate private lounge is not available. The home provides the specialist equipment necessary to maximise service users’ independence. Overall, service users can expect the home to be clean and hygienic. EVIDENCE: During a tour of the premises, the inspector observed that the home is comfortable and overall well maintained. However, a tour of the premises showed that the shower rooms need to be updated; tiling and grouting in particular need to be replaced. One bathroom has a mis-matched bathroom suite where the avocado toilet has been replaced with a white pan but the rest of avocado suite still in place. The furnishings throughout the home are Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 17 domestic in nature and there is ample space for wheelchair users to move freely around the home. Service users’ bedrooms are decorated to individual tastes and there is plenty of evidence of personal possessions. It was noted at the last inspection that there is no separate lounge space where service users can meet privately with visitors. The manager explained that one service user has requested a move to another SCOPE home and when that process is complete the bedroom will be converted into a new lounge area. Throughout the home there is evidence of aids, adaptations, overhead tracking for hoists and assisted baths that are appropriate for the needs of the service users living in the home. Since the last inspection a new call system has been installed with pads that are easy for service users with physical disabilities to use. A tour of the premises showed that the home has a reasonably good standard of cleanliness. However, there could be improvements in some areas; in particular the flooring in one of the kitchens has discoloured sealant between the skirting board and the floor. There are no unpleasant odours throughout the home. The laundry facilities are domestic in nature and appropriate for the size of the home. Staff records examined contain evidence that staff receive training around infection control. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall service users are supported by competent and qualified staff who receive appropriate training, although further staff need to obtain a National Vocational Qualification. Service users are protected by the home’s recruitment policy and procedures. Service users benefit from well-supported and supervised staff. EVIDENCE: Overall the staff team are competent and qualified to carry out their roles. Information provided in a Pre Inspection Questionnaire indicates that out of a team of 14 care staff, 3 have completed a National Vocational Qualification (NVQ) at level 2 or above. Although this falls short of the National Minimum Standard recommended 50 , the manager is committed to increasing the numbers of staff with an NVQ qualification. The home has a robust recruitment process in place following SCOPE procedures to ensure the protection of service users. On the day of the inspection visit a sample of three staff files were examined. All contain the Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 19 required documentation including application forms, two written references, appropriate evidence of ID and enhanced Criminal Record Bureau (CRB) checks. Staff files are well organised. Staff records examined show that the home has a good training and development system. The staff training and development files show that training includes Health & Safety, Manual Handling, Food Hygiene, Fire Safety, First Aid, Care of Medicines, Enteral Feeding Pump training and POVA. Evidence was also seen that staff have a comprehensive in-house induction. Records examined show that supervisions take place regularly and supervision contracts are in place. Staff spoken with said that they feel well supported. Staff files contain evidence that staff receive induction training. Annual appraisals that identify training needs and Personal Development plans are in place. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and has policies and procedures in place to safeguard the rights of the service users. Overall service users views are taken into account through the Quality Assurance process. The home ensures the health, safety and welfare of service users are promoted and protected. EVIDENCE: The registered manager has a number of years management experience. She holds a nursing qualification and has completed the Registered Manager’s Award. The home has a range of policies that the manager implements to ensure the home is well run in the interests of service users. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 21 Since the last inspection progress has been made with the homes Quality Assurance system. As part of the process, service user surveys and staff surveys have been completed and analysed. Ten responses have been received to the ‘Listening to you’ questionnaire sent to visitors. Minutes of Quality Action Group meetings were also examined. The manager is in the process of developing the action plan from the collated information. The home has appropriate policies and procedures in place around infection control, fire safety, first aid and Health & Safety. H & S records examined show that appropriate Health & Safety checks are carried out. Staff records examined show evidence of training around H & S processes (see evidence for standard 35). Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 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 OICE OF HOME Standard No Score 1 X 2 3 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 2 25 X 26 X 27 X 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA24 Regulation 23(2)(d) Requirement Timescale for action 30/04/07 2. YA28 23(2)(i) The registered manager must ensure all parts of the care home are kept clean and reasonably decorated. The registered manager must 30/04/07 ensure suitable facilities are provided for service users to meet visitors in communal accommodation and in private accommodation which is separate from the service users’ own private rooms. 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 YA17 YA32 Good Practice Recommendations The registered manager should consider improving the dining tables to give service users a better dining experience. The registered manager should continue to support staff to achieve NVQ awards. Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Henderson and Harvard DS0000017845.V324225.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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