CARE HOMES FOR OLDER PEOPLE
Heyberry House 3 Ashville Road Birkenhead Wirral CH41 8AU Lead Inspector
Beate Roth Unannounced Inspection 6th March 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 Heyberry House DS0000018894.V329336.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. Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Heyberry House Address 3 Ashville Road Birkenhead Wirral CH41 8AU 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) 0151 653 3225 sharon.blackwell@anchor.org Anchor Trust Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th March 2006 Brief Description of the Service: Heyberry House is a purpose built three storey residential home that is registered to provide personal care for 41 older people. All bedrooms are single with en-suite facilities. There is one large lounge/dining room and a conservatory on the ground floor. In addition, there is a seating area off the corridors on each floor of the home. Specialist bathing facilities are provided in the home and a passenger lift services all floors. There is a garden/patio area at the rear of the home, which overlooks Birkenhead Park. Parking is available at the front of the building. The home is situated in the Birkenhead Park area of Wirral close to Claughton village and Birkenhead town centre, it is serviced by both rail and bus services. At the time of this inspection, the weekly fees for the home ranged from £340.01 to £394.15. Additional charges are made for hairdressing and chiropody. A service user guide and a statement of purpose, which describe the services offered at Heyberry House is made available to new residents, their relatives and professionals before a resident comes to live at the home. A copy of the most recent inspection report can be obtained from the manager. Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 6 hours and is based on a visit to the home. The inspection is also informed by information received about the service since the last inspection and by questionnaires completed by the residents. During the site visit to the home time was spent in the office looking at a sample of records and policies and procedures and talking to the manager. A tour of the home was undertaken. The inspector spoke with residents, a relative and staff and made observations of the care given by staff. What the service does well:
Residents’ benefit from being able to make trial visits. This assists residents to make a decision about whether the home is right for them. Residents have their health and care needs well met. Staff are aware of the needs of residents and how to meet them. Residents spoken with were very positive about the care they receive. They said they are “happy with the support,” “it’s no bother to staff when I need something they arrange everything” and the “staff are very good.” Observations indicated that residents are treated with respect. Residents said staff are “very nice,” “polite” and that staff make it feel “ home from home.” The wellbeing of residents is promoted by the flexibility of the daily routines, visitors being made welcome to the home and the provision of well balanced, appealing meals. A good range of activities are available for residents to take part in should they so wish. The home has a complaints system which residents know how to access. The procedures at the home and training provided to staff around adult protection safeguard residents. The home is clean and well presented and provides a comfortable and pleasant atmosphere. Staff are well supported to meet the needs of residents. Staff spoken with made positive comments about working at the home, comments included the home is “a nice place to work” and “we get good training.” The management arrangements support the wellbeing of residents. The home has good systems for monitoring the quality of the service it offers to residents. Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 6 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. Heyberry House DS0000018894.V329336.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 Heyberry House DS0000018894.V329336.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): 2, 3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New residents can visit the home, which assists them to decide if the home is right for them. The wellbeing of residents is supported by the contracts they have with the home. Records show that a full assessment has not been carried out for all new residents before they are admitted to the home. EVIDENCE: The records for three new residents were seen. These showed that an assessment of a potential residents needs had been carried out before they moved to the home. The assessment forms allow for a complete assessment of need to be undertaken however, some of the assessments seen were not detailed enough and some parts of the assessment were not complete. The manager reported that members of care staff had completed these assessments and that care staff have not received training to complete this task. The manager reported that a senior member of staff oversees assessments. At previous inspections the manager, deputy or senior carers,
Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 9 have undertaken the initial assessment of prospective residents and complete assessments have been carried out. Senior staff are trained to complete this task. All residents whose records were seen were appropriately placed at the home. There was evidence that information is gathered from social workers and health professionals to inform the initial assessment. Potential residents can make several visits to the home before deciding to move in. During these visits they can meet staff and current residents and view the home. Residents and a relative spoken to said that they visited the home before deciding whether to move in. 2 residents who returned questionnaires said that they were given enough information about the home before they moved in so they could decide if it was the right place for them. Records showed that residents have a contract that contains all the information needed. Residents are admitted on a 6-week trial basis. Residents spoken with and 2 the residents who returned questionnaires said that they have a contract, which outlines the services provided at the home. Heyberry House DS0000018894.V329336.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of residents are not fully supported by the care planning processes in place at the home. Residents feel they are treated with respect. The management of medication supports the well being of residents. EVIDENCE: A sample of residents’ records were looked at and indicated that residents have a care plan in place. Care plans are produced on admission, and are reviewed after six weeks. At six weeks a more detailed plan is produced with the input and cooperation of the resident. Care plans provide for information to be recorded around residents’ specific needs that would promote equality such as their racial, religious and language needs. Risk factors are identified and when required management plans are put in place. A sample of risk management plans were seen and in general provided
Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 11 sufficient information for staff to refer to. A risk assessment around falls did not contain clear guidance for staff on how to prevent a fall. A complete risk assessment was not available for a resident who administers their medication. There was some information available but this was not recorded into a full assessment. Some risk assessments were recorded together, which did not provide clear information for staff to refer to. For example one assessment looked at risks around self-administering medication and bathing together. Some improvements need to be made to written guidance available to staff around health care tasks. There was no information in care plans around the assistance staff give a resident to use oxygen or assist residents who may need to use equipment to help them eat. A record is not made daily around the wellbeing of a resident and the care given. A record is now only being made when there is a significant issue or there is any information to alter the general plan of care. This does not provide evidence that the home is providing the care detailed in the care plan or gives an indication of the residents physical, social and emotional state. These records are important for informing ongoing care planning and need to be made on a regular basis. Residents spoken with were very positive about the care they receive. They said they are “happy with the support,” “it’s no bother to staff when I need something they arrange everything” and the “staff are very good.” The records at the home indicated that referrals are made to health professionals in accordance with the needs of residents. A record is made of visits by health professionals and the outcome is documented. Residents spoken with said that their health needs are well met. An appropriate record of accidents is maintained. Since the last inspection the arrangements for the storage and transportation of medication have changed which has resulted in a better system for the dayto-day management of medication. The home provides secure medicine storage facilities. Staff who administer medication have received appropriate training. A sample of medications and the corresponding records were examined and were found to be in order. Staff interviewed were aware of how to handle medication safely. Staff receive training and guidance around how to meet a residents needs in a dignified manner and how to respect their privacy. The staff were observed to address residents in a respectful and polite manner. The residents spoken with and those who returned questionnaires said that their privacy and dignity is observed by the staff. Residents said staff are “very nice,” “polite” and that staff make it feel“ home from home.” Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 12 Staff spoken with said that a good service is given to residents. The comments staff made included “I would recommend the home to a relative,” “this is a nice place, people are well looked after” and “residents can make choice.” Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including visiting the service. The home maintains community links, encourages visitors and encourages residents to make choices, which ensures that the social and emotional needs of residents are promoted. Residents receive appealing, well-balanced meals in pleasant surroundings. EVIDENCE: Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 14 An activities co-ordinator is employed for 20 hours per week and organises two activities within the home a day such as bingo, board games, cards, knitting, crafts, quizzes and musical exercises. Residents are kept informed about the activities available by care staff and through written information in the reception area. Records indicate the interests of residents, which inform the activities offered. Residents spoken with and those who returned questionnaires made positive comments about the activities available. The effort and commitment put into the range of activities provided is to be commended. The care plan details the key relationships residents wish to maintain and the community based activities they were involved in prior to living in the home. The home operates an open door policy to visitors. This visiting policy was displayed in the entrance hall and is in the service users guide. During this inspection, the residents who were spoken with said they felt their visitors were made to feel welcome. A number of visitors were observed visiting the home during the inspection and were greeted warmly by the staff. Discussion with residents and staff indicated that the home encourages residents to make decisions about their day-to-day lives at the home, such as when they will get up and go to bed and what they will do each day. Each of the residents’ bedrooms seen had been personalised with items brought in from their own homes. The contact details for advocacy services are available. Observations of the dining area indicated that a pleasant environment is provided for residents to have their meals. Residents were appropriately assisted to eat their meals by staff as necessary. Liquidised food was available to residents in accordance with their needs and was very well presented. There is a choice of meals. The food prepared looked appetising. The food was sampled and was of a good quality. Menus are displayed in the main reception for residents and their visitors to view. Visitors may eat with the person they are visiting as long as sufficient notice is provided. The records of menus indicated that a variety of meals that would provide a balanced diet are available. Any special dietary needs are written in to a residents care plan. A dietician is consulted where necessary. When asked about the food provided, residents described the food as “excellent” and said it is made from fresh ingredients and that “a variety is offered.” 2 residents who returned questionnaires said they always like the food at the home. Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system which residents know how to access. The procedures at the home and training provided to staff around adult protection safeguard residents. EVIDENCE: The home has a detailed complaints’ procedure. On admission to the home, each resident is given a copy. A record is made of any complaints received. An examination of this record indicated that there had been one complaint since the last inspection, which had been responded to in a timely and satisfactory manner. During the inspection, the residents who were spoken with confirmed that they would be confident to approach the manager or other senior members of the management team, if they had a complaint or concern about the service. The 2 residents who returned questionnaires knew how to make a complaint. All staff have attended adult protection training. Staff spoken with were aware of the procedure to follow in order to protect older people from abuse. A copy of Wirral Borough Council’s adult protection procedure is available at the home. Records showed that the home takes appropriate action to safeguard residents when issues around their welfare arise.
Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 16 Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 17 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, 24 and 26 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 maintained and there is a good standard of cleanliness and hygiene, providing residents with a pleasant environment to live in. EVIDENCE: A tour of the home was undertaken. This included an inspection of the communal areas and a sample of the bedrooms. This indicated that the home is well maintained and decorated to a high standard. There is a rolling programme of re-decoration and refurbishment. The bedrooms seen were suitably furnished. All bedrooms are single with en-suite sink and toilet. Residents have personalised their bedrooms. Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 18 The water accessible to residents is maintained at a safe temperature. Covers have been fitted to electric storage heaters in bathrooms and bedrooms to prevent any possible risks to residents. Since the last inspection covers have been fitted to the storage heaters in communal areas. All areas of the home seen were clean and fresh smelling at the time of the inspection. It was evident that the domestic staff are working hard to maintain good standards. Appropriate laundry facilities are provided by the home. Preferred laundry routines are discussed with residents and documented. Procedures relating to COSHH and protective clothing are available for domestic staff. Residents and a relative spoken with said the home is “kept clean” Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of residents are met by the numbers of staff and the training staff have received. The recruitment practices at the home safeguard the welfare of residents. EVIDENCE: The rota and a discussion with the staff and residents indicated that there are sufficient numbers of staff to meet the needs of the residents living at the home. There is a clear staff structure at the home that includes the manager, deputy manager, senior care staff, care staff and ancillary staff. The 2 residents who returned questionnaires and residents spoken with said that staff are always available when they are needed. The records of 3 new members of staff who have been employed since the last inspection were examined. These records were very well maintained and contained all the required information. Residents are involved in the recruitment of new staff and form part of the interview panel. The home has an equal opportunities monitoring policy in operation. All staff have access to the General Social Care Council’s Code of Practice and staff have been made aware of the standards expected of them.
Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 20 Staff spoken with made positive comments about working at the home, comments included the home is “a nice place to work” and “we get good training.” Staff spoken with were aware of the rights of older people and how to promote them. Staff are actively encouraged to undertake an NVQ in Care of the Elderly. At present 63 of staff have an NVQ and additional staff are currently undertaking this training. An induction and foundation training programme are provided to all new staff. This training meets the National Training Organisation specification. Records of this induction were seen and covered information essential to prepare a member of staff to work at the home. The induction covers health and safety matters, protection of older people from abuse, good care practice, promoting equality and diversity and the general operation of the home. A new member of staff was interviewed and reported that they had received the training and guidance they needed to be able to appropriately care for the residents. New staff work alongside existing staff until they have been assessed as competent. Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 21 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, 32, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements at the home support the wellbeing of residents. The quality of the service is well monitored. The safety of residents is well promoted. EVIDENCE: The manager has managed the home 9 months and has made an application to CSCI to become the registered manager for the service. The manager was the former deputy manager of the home and she has a number of years experience in working with older people. The manager has a relevant qualification in care and management and has attended training to keep her skills and knowledge up to date.
Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 22 The staff interviewed were clear about the lines of accountability at the home. Staff meetings and residents meetings are held on a regular basis. Staff and residents spoken to said that their views about the day-to-day operation of the home are sought. Records of residents meetings showed that issues that are important to the residents are discussed such as food and activities. There are comprehensive quality assurance and monitoring systems in place at the home. The views of relatives and other stakeholders are sought regarding the operation of the service. A coffee morning for relatives and residents is to take place next month, which will be an opportunity to discuss how the home is operating. The regional manager undertakes monthly regulation 26 visits which includes discussions with the staff and residents. A copy of these reports are sent to CSCI. The manager and senior managers regularly inspect the records and the home environment. Staff reported that the manager, deputy and senior staff gives them a clear sense of direction and asks them their views on the operation of the home. Staff reported that they have regular supervision and are well supported. The manager ensures that CSCI are informed of any relevant issues affecting the home. The manager ensures that any requirements identified by CSCI are attended to without delay. The home holds personal allowances on behalf of some residents. The records of this were seen and were accurately maintained. There was evidence of auditing by a senior manager from Anchor Trust and the home’s manager in respect of money held on behalf of residents. The home’s administrator was spoken with and was very aware of the processes to be followed in order to safeguard resident’s finances. Residents are able to bring personal possessions to the home The records of the safety checks of the fire alarm and emergency lighting were in order. Fire drills are held on a regular basis. A gas safety certificate was available. Evidence that the electrical wiring at the home is safe was available. Training records showed that staff are given appropriate training in safe working practices, including fire safety training. Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 23 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 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X 3 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14 Requirement The registered persons must ensure that accommodation is not provided unless a suitably qualified or suitably trained person has assessed the prospective residents’ needs. Timescale for action 06/03/07 2. OP7 15 The registered persons must 06/03/07 ensure that care plans provide clear information for staff on how they are to meet the needs of residents. A record must be made of the wellbeing of a resident and the care given. 3. OP9 13 The registered persons must 06/03/07 ensure that a complete risk assessment is available for any resident who administers their medication. Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 25 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 OP7 Good Practice Recommendations It is recommended that a daily record be made of the wellbeing of a resident and the care given. Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Heyberry House DS0000018894.V329336.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!