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Inspection on 16/02/07 for Hepworth House

Also see our care home review for Hepworth House for more information

This inspection was carried out on 16th February 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Staff at this home work hard to build supportive relationships with the residents. All residents spoken with felt that the staff were friendly and very kind to them. One resident said " we can have such a laugh at times". We observed staff speaking to residents in a respectful manner during this inspection and giving reassurance when it was needed. Residents feel confident and comfortable in the company of the staff at this home. Management at the home are also careful when recruiting new staff. There are several things that the home must have in place before they allow anyone to work in a home. These include at least two written references and a check known as a criminal records bureau check. This means that a safety check has been undertaken to help them make a decision as to whether someone is suitable to work with residents. All the information needed was in place before staff worked at the home so protecting the residents. Staff are also good at contacting the Doctor or other healthcare professionals when a resident needs their help. Documents seen at this inspection showed that residents had received regular visits and appointments with General Practitioners, chiropodists, speech therapists, dieticians and physiotherapists.This means that residents benefit from the expertise of healthcare professionals in improving their physical health.

What has improved since the last inspection?

When safety checks are done at the home, for example checking water temperatures to make sure they are not to high, staff at the home have introduced a system that records what they have done. This means that it is clearer what action they have taken to reduce the risk of accidents to residents.

What the care home could do better:

The home uses a system for medication that is known as a monitored dosage system. This is where the supplying chemist provides a sealed individual unit for each resident for each medication. This system reduces the risk of medication errors as staff should take a tablet from a unit and then give this straight to the resident. However when we visited we saw a member of staff had taken all the medication out of these units and then put them in different pots, and then went round and gave them out. This is known as secondary administration and it should not happen as the risk of residents receiving the wrong medication is to high. Locally there is a policy known as the Protection of Vulnerable Adults policy. This gives guidance on what should be done if there is alleged or suspected abuse of a vulnerable person. All homes must have a copy of this and their own policy must include the information that the local policy details. This home did not have the most recent guidance and its own policy was not up to date. It is important that this is in place and that all staff are aware of what they should do, so that residents are protected and benefit from a multi agency approach.

CARE HOMES FOR OLDER PEOPLE Hepworth House 1 St Georges Road Bedford Bedfordshire MK40 2LS Lead Inspector Katrina Derbyshire Unannounced Inspection 16th February 2007 11:00 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 Hepworth House DS0000014911.V329494.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 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. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hepworth House Address 1 St Georges Road Bedford Bedfordshire MK40 2LS 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) 01234 262139 01234 272927 hepworthhouse@waitrose.com Mr Keith Hepworth-Lloyd Mrs Prima Hepworth-Lloyd Mrs Prima Hepworth-Lloyd Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18) of places Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: Hepworth House is situated in a pleasant residential area of Bedford. It is within easy walking distance of the town centre and close to local amenities such as local shops, schools and Churches. The home is converted from two domestic style properties. There is a garden surrounding the home, which is laid to lawn and flower- beds. There is unrestricted road parking in the area for staff and visitors. The home has undergone many changes in the last few years and currently provides accommodation for 18 residents over the age of 65 years. 16 of the rooms are single rooms with en-suite facilities. There are two lounge/diners and a sunroom on the ground floor and a lounge on the first floor. Communal bathrooms and toilets are located on the ground and first floor. The fees for this home vary from £425.86 per week for residential placements, to £455.00 per week. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 16th February 2007. The Registered manager Mrs. Prima Hepworth-Lloyd who is also joint owner of the home was present throughout the inspection. During the inspection areas of the home were visited and the inspector spent time with residents’ mainly in the ground floor sitting area of the home. The care of two residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents and their feedback have been used alongside information from the home to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: Staff at this home work hard to build supportive relationships with the residents. All residents spoken with felt that the staff were friendly and very kind to them. One resident said “ we can have such a laugh at times”. We observed staff speaking to residents in a respectful manner during this inspection and giving reassurance when it was needed. Residents feel confident and comfortable in the company of the staff at this home. Management at the home are also careful when recruiting new staff. There are several things that the home must have in place before they allow anyone to work in a home. These include at least two written references and a check known as a criminal records bureau check. This means that a safety check has been undertaken to help them make a decision as to whether someone is suitable to work with residents. All the information needed was in place before staff worked at the home so protecting the residents. Staff are also good at contacting the Doctor or other healthcare professionals when a resident needs their help. Documents seen at this inspection showed that residents had received regular visits and appointments with General Practitioners, chiropodists, speech therapists, dieticians and physiotherapists. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 6 This means that residents benefit from the expertise of healthcare professionals in improving their physical health. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 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 Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The changes in the assessment processes at this home have ensured that staff now have sufficient information prior to a residents admission to ascertain if they will be able to meet their needs. EVIDENCE: Two files were examined of residents one of whom had only recently been admitted to the home. One resident had a comprehensive pre-admission assessment and information from the commissioning agency was also noted to be in place, this information was for the resident admitted recently into the home. The other assessment was not to this standard, however the manager explained that the resident had lived at the home for many years and that improvements and changes had been made since that time. Information was Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 9 sufficient to provide the staff at the home with details for them to make a decision on whether they could meet the needs of the residents. Intermediate care is not provided at this home. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At times the administration of medication in this home is insufficient and places the residents at risk of not receiving the correct medication. EVIDENCE: Care plans were examined for the two residents selected for case tracking. The content of the plans seen were noted to have improved since the homes previous inspection. Guidance to staff was clear, one example was a plan in place for the mobility needs of one resident, the plan stated that staff should offer support to the resident, ensure that the resident had their walking frame and the level of encouragement that should be offered. However a plan was not in place for each assessed need. One resident had been assessed as being at very high risk of falls, this had in fact been the main reason for their Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 11 admission to the home but there was no plan in place. A requirement is made that a plan must be in place for all assessed needs to ensure continuity of care for all residents. Residents through discussion and feedback from the returned comment cards indicated that they had access to advice, treatment and support from healthcare professionals. Documents seen within the individual care records showed regular visits from Doctors and District Nurses. Advice given from a dietician was seen to be followed by staff in the provision of a special diet for one resident. In addition District nursing notes were kept within the home and staff through interviewing demonstrated that they had a good level of knowledge of the care that was being provided, and how they should support the resident in this area under the guidance of the nursing services. All residents spoken with at this visit and all returned comment cards stated that they felt that staff at the home respected their privacy and dignity. One resident said, “l really did not want to move into a home, l wanted to stay in my own home, but the staff here treat me so well, as their equal really, they have just made this move easier”. Observation made during the lunchtime meal showed one staff member offering assistance to one resident who was unable to see. The staff member throughout this time explained every action that she was taking and the food that she was placing on the fork for the resident to eat. The resident had also indicated that they wished the staff member to hold one of their hands during this time; the staff member did this immediately providing constant reassurance in a very supportive and dignified manner. Medication records seen were noted to be sufficient. Records of medication ordered, received and returned were kept by the home. Storage of medication was noted to be in a locked cupboard along the ground floor corridor of the home. A sealed dispensing system was being used and coloured cards were seen to be stored in the medication cupboard. However observation of the administration of medication to all residents at the lunchtime meal was seen to be unsafe and place all residents at risk. A staff member had taken the medication from the sealed dispensing cards and then placed them in pots. They had then placed lids on the pots with resident’s names, placed these on a tray and then went round with all of them giving them to residents. The signing of the records was then done altogether after this. This is very unsafe practice and was discussed with the manager at the time of this inspection and a requirement has been made. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel that activities provided at the home are sufficient to meet their social needs. EVIDENCE: Activities are on offer in the home. Information supplied by the home show that residents attend day centres, and a range of activities take place in the home including painting, drawing, games and music entertainment. Outside entertainment, for example the provision of music also is available in the home. Residents said that they were satisfied with the level of activity available. Residents are encouraged to join in, but can choose whether or not to participate. Hairdressing is also arranged by the home so residents if they wish can have their haircut or set. In addition residents who wish to have a newspaper delivered do so, and staff at the home arrange for this. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 13 Residents are able to bring personal possessions into the home and the evidence of this was seen in resident’s individual rooms. Residents confirmed that they are consulted and are given choices as to how they conduct their lives within the home; choices offered included meals, activities and relationships. Nutritional risk assessments were seen within the residents care records. A choice of meals is available, observation of the lunchtime meal showed it to be unrushed and enjoyed by the residents from their positive comments. It was also noted that residents dietary preferences based on their cultural background were seen to be met. All residents spoken to commented on how the staff in the home always made their friends and families feel welcome. They could see their relative in private and felt that the home were good at keeping them up-to-date on any changes concerning their wellbeing. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The policies and systems in place for the protection of vulnerable adults is not sufficient to ensure residents would receive the support from multi agencies as directed by local policy. EVIDENCE: The homes complaints procedure was examined. It gave simple guidance on how to make a complaint and gave timescales in which the home would respond to a complainant. Documents were viewed of complaints received and how the home had responded to these. Responses and explanations given were noted to be both comprehensive and courteous. Where the home had not met the standard of care, an apology had been given and explanation as to why, and changes that the home had implemented to reduce the risk of it happening again. Residents comments received through returned comment cards indicated that they were aware of how to complain and to whom. The homes policy on abuse did not reflect the management and reporting as detailed within the local Protection of Vulnerable Adults policy. Also the home did not have in place the most recent multi agency guidance on how to report Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 15 a suspicion or alleged abuse. Staff training records also showed that not all staff at the home had received training in this area. One staff member when questioned on how they would report suspected abuse was not clear on the homes responsibility to report it to other agencies. A requirement relating to this has been made. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The décor, fittings and furnishings at this home are sufficient to provide a comfortable environment for the residents to live in. EVIDENCE: Communal areas alongside individual rooms of residents were seen at this inspection. In the main many areas were decorated to a satisfactory standard. Two individual rooms that were seen had been decorated to reflect the personalities of the residents and contained personal items, for example photographs and pictures. However other areas in the home require redecoration and this was discussed with the manager at the time of the inspection. One example was the en suite Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 17 to one residents’ room that had water damage along the walls and required redecoration. All areas were seen to be clean and free of any odours. Residents spoken with said that they found the home to be comfortable and some residents spoke of brining items of furniture in with them when they moved to the home for their individual room. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment systems at this home are sufficient to protect the residents. EVIDENCE: Staff files were examined to look at recruitment practices at the home, all were noted to contain application forms, evidence of identification and Criminal Records Bureau checks. Evidence of a thorough selection process was in place. Staff training records were also examined and showed that staff had attended a variety of courses and workshops including health and safety, food hygiene and management of medication. However the induction of new staff does not follow the national occupational standards in this area and this was discussed with the manager at the inspection. Staffing rotas submitted by the home showed that the number and skill mix of staff were sufficient to meet the needs of the residents. Residents and staff felt that there were enough staff to care for the residents, it was reported that at Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 19 times residents would need to wait for assistance if help was being offered to another resident but that this would normally only be for a few minutes. Staff through discussion demonstrated that they were aware of the needs of the residents as recorded within their care records and were able to describe the individual. It was observed that the interaction between the staff and residents was positive and showed that supportive relationships between them had been established. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager at this home provides clear direction and leadership so staff feel supported in meeting the needs of the residents. EVIDENCE: As previously reported the Registered Manger has many years experience of care, she is a Registered Nurse and has a post registration qualification in Business Management. The home has achieved the “Investors in People” award in recognition of the training and support provided to staff and the leadership style of the manager and has just been assessed again. Staff spoken to felt the manager was approachable and went out of her way to try and help them with Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 21 their development. There are clear lines of accountability in the home and there is a deputy manager in post. Residents spoken to also felt the manager was always around and they would have no hesitation in speaking to her. The home had sent out questionnaires to relatives, residents and visiting professionals to gain their views of the standard of care at the home, those responses seen showed that this had been undertaken periodically to a small number throughout 2006. However the home may wish to consider seeking all residents’ views so that the action that they take in response to their feedback can be made at the same time. A limited amount of money is managed on behalf of a small number of residents at this home. Balances checked were noted to be correct and receipts and records were in order. Documents pertaining to the management of Fire, environmental Health and internal safety checks were seen. All were up-to-date and demonstrated that required safety measures were in place to meet the relevant legislation in this area. Staff and their training records confirmed that they had been trained in a variety of Health and Safety areas including moving and handling, food hygiene and infection control. The moving and handling techniques observed during the visit were good, with appropriate use of slings and lifts, and the use of footrests on wheelchairs to avoid injury to staff and residents. Hepworth House DS0000014911.V329494.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 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hepworth House DS0000014911.V329494.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 OP7 Regulation 12(1)(a), 15(1)(ad) 12(1)(a) 13(2) & 13(4) Requirement A care plan must be in place for all the assessed needs of residents to ensure continuity of care. Secondary administration of medication must cease and medication records must be signed immediately after administration to reduce the risk error. All staff must receive training in the protection of vulnerable adults following local and national guidance. Timescale for action 01/04/07 2. OP9 15/03/07 3. OP18 12, 13 & 18 01/04/07 4. OP18 12, 13 & 18 The manager must secure a copy 15/03/07 of the most recent local policy for the protection of vulnerable adults to ensure the correct reporting of suspected abuse takes place. Repair and redecoration of areas in the home must take place to ensure all residents environment is to an acceptable standard. DS0000014911.V329494.R01.S.doc 5. OP19 23 15/06/07 Hepworth House Version 5.2 Page 24 6. OP30 12 & 13(4) & 18 The induction of staff must meet the national occupational standards. 31/03/07 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 OP33 Good Practice Recommendations The home should consider seeking all residents’ views so that the action that they take in response to their feedback can be made at the same time. Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Hepworth House DS0000014911.V329494.R01.S.doc Version 5.2 Page 26 - 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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