Inspection on 04/10/05 for Highland House Retirement Home

This inspection was carried out on 4th October 2005.

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

Other inspections for this house

Highland House Retirement Home 25/04/07

Highland House Retirement Home 29/06/06

Highland House Retirement Home 19/01/06

Highland House Retirement Home 24/01/05

Highland House Retirement Home 27/09/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Highland House Littlebourne Road Canterbury Kent CT3 4AE Lead Inspector Mark Hemmings Announced 4 October 2005 at 10:00am th 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 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. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Highland House Retirement Home Address Littlebourne Road, Canterbury, Kent. CT3 4AE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01227 462921 Mrs Marian Walsh Mrs Susan Page Registered Care Home 28 Category(ies) of Older People aged 65 or over registration, with number of places Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Highland House (the Home) is registered to provide accommodation and personal care for 28 older people (service users). The Home is owned privately by the Registered Provider. Date of last inspection 24.01.05 Brief Description of the Service: The premises are a two storey older property, to which purpose built extensions have more recently been added. Most of the bedrooms are located on the ground floor and most of them are for single occupancy. All of the bedrooms have a private wash hand basin and toilet. Four of the bedrooms also have a private shower. There is a stair-lift which gives step free access to all parts of the accommodation used by service users. The premises are fitted with a call bell system which is designed to assist service users to summon help from staff should it be needed. The property is set back a little from one of the main roads into Canterbury. There are no shops within easy walking distance. To the rear of the premises there is a large enclosed garden. The day to day operation of the Home is overseen by the Registered Provider and by the Head of Care. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was announced and it took about nine hours to complete over the course of two days. During this time, the Inspector spoke with or spent time with ten service users. Also, he spoke with the Registered Provider, the Head of Care and with the Administrator. The Inspector examined various records and he spoke with care workers and with housekeeping staff. The Inspector looked at various parts of the accommodation. This included (by invitation) one service user’s bedroom. The Home continues to provide the service users in residence with the support and assistance they need. What the service does well: What has improved since the last inspection? The Registered Provider has continued to address minor defects in the premises as part of an ongoing programme of maintenance and repair. The Registered Provider has installed guards to protect the heated surfaces of a number of radiators. Also, she has made arrangements which will see guards Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 6 fitted to all of the remaining radiators in the Home in the near future. The Registered Provider has prepared the first of what will be annual Quality Reports. These will list any improvements suggested by service users and they will detail what the Registered Provider intends to do about them. 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. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 and 6. Prospective service users are given the information they need to make an informed decision about living in the Home. Each service user receives a written statement of the terms and conditions of their residency. Service users’ needs for assistance are assessed before admission. Service users are confident that their needs for personal care will be met when they enter the Home. Prospective service users and their representatives are encouraged to visit the Home before a decision is made about moving in. Service users who receive intermediate care in the Home, are assisted to return home. EVIDENCE: There is a Service Users’ Guide. This is a brochure which prospective service users are given and which outlines the facilities and services provided in the Home. In addition to this, the Registered Provider and the senior staff speak with prospective service users to answer any remaining questions they may have. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 9 Each service user receives a written statement of the terms and conditions in accordance with which the Registered Provider delivers accommodation and personal care services in the Home. The document is suitably detailed and it is clearly laid out. The Registered Provider said that all new service users and their representatives are given an opportunity to talk through the document with a senior member of staff, so that any necessary clarification can be given. Service users say that they were confident at the point of admission to the Home, that their individual needs for support could be met reliably and consistently in Highland House. The Registered Provider is aware of the responsibility placed upon her to ensure that only people whose needs for assistance can be met reliably, are admitted to the Home. The Inspector reviewed the circumstances of one of the recent admissions to the Home. He concluded that the decision to offer a place had been suitable given the particular needs of the person in question. A small number of people are accommodated in the Home for shorter periods of time. Often this is done to enable them to regain a suitable measure of independence before returning home after a stay in hospital. Suitable arrangements are in place to facilitate this move, should it remain the wish of the service users concerned. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Service users are confident that their present and future needs for personal care will be met in a reliable and consistent manner. They are suitably consulted about the assistance they receive. Service users’ health care needs are met fully. Service users are assisted to manage their own medication if this is appropriate. Service users consider that staff are respectful and that they appreciate their needs for privacy. EVIDENCE: There is a service user plan for each service user. These documents describe the assistance which each person has agreed to receive. The Inspector sample checked several of these plans and he found them generally to be suitably detailed. There was an omission in relation to Service User A, which the Head of Care said will be rectified by 10 October 2005. Service users say or indicate that they are consulted about the contents of the plans. Service users consider that they receive all the assistance they need. Care workers assist service users in a manner consistent with that described in the individual service user plans. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 11 Service users say that care workers assist them to maintain their health. There is evidence which shows that service users’ doctors are called promptly when there is a concern about someone’s health. The Commission has not received any expressions of concern from members of the primary health care team about their working relationships with the Home. Service users say that they would be free to manage their own medication if this were their wish. At the time of the present inspection visit, none of then had chosen to act in this capacity. The Home generally operates suitable arrangements with respect to the storage and administration of service users’ medication. However, two categories of administrative errors in some of the records were identified. The Head of Care took appropriate steps to ensure the correction of both of these oversights from the first of the two days of the inspection visit. Service users say that care workers are both cordial in their manner towards them, while at the same time being respectful of their individual preferences. The Inspector noted several occasions on which care workers varied their approach according to what they know to be service users’ different expectations of them. For example, some people wanted to spend quiet time in their bedrooms, while others wanted to laugh and chat with staff in the main lounge. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Service users have access to a suitably varied range of social activities. Service users are assisted to maintain normal contacts with family and friends. Service users are enabled to exercise suitable choice in their everyday lives. Service users are offered a suitably healthy diet. EVIDENCE: Various social activities are convened in the Home. The Inspector overheard songs in the lounge on the first day of the inspection. On the second day, a very popular bingo session was planned. Service users consider themselves to be occupied suitably. Service users say that they are assisted to maintain contacts with members of their families and with friends who do not live in the Home. The Inspector has not received any expressions of concern about this matter from members of service users’ families. Service users say or indicate that the pace of daily life in the Home is relaxed and unhurried. There is evidence of service users exercising choice. This includes the fact that no one is pressured to participate in the social activities Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 13 held in the main lounge. There is another smaller lounge to which people can and do retire if they prefer to spend their time in another way. Service users say that they receive good quality meals and they always have enough to eat. Indeed, there was considerable praise for the chef, with service users liking his practice of asking them how particular dishes have been received. The Inspector joined service users for lunch on both of the days of the inspection visit. He noted that the meals served were presented attractively and that the food was well prepared. The written menu indicates that service users are offered a normally balanced diet. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18. Service users consider that their views are listened to and that as necessary they are acted upon. Service users’ citizenship rights are respected. Service users are protected from abuse, neglect and self harm. EVIDENCE: There is a complaints procedure which explains how service users and other stakeholders can make a complaint about any aspect of the facilities and services provided in the Home. Service users say or indicate that they are confident that any matter they raise will receive serious attention and if possible will be addressed. Service users’ citizenship rights are protected. For example, they are assisted to ensure that their names are entered in the Electoral Register. Also, they are assisted to cast their vote in elections, if this is their wish. Care workers have a good understanding of what constitutes good care practice. As part of this, they are aware of the need to be alert to instances which might jeopardise the well-being of a service user. Service users say or indicate that they feel safe living in Highland House. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. Service users are provided with a satisfactory environment. There is an adequate provision of shared use facilities. Suitable provision has been made to assist service users who experience a measure of reduced mobility. Service users’ bedrooms are suitably equipped and have been personalised by their occupants. Service users live in comfortable surroundings. There is an omission in what generally is a suitably safe environment. The accommodation is presented to a normal domestic standard of cleanliness. EVIDENCE: Service users say or indicate that they are comfortable living in Highland House. They consider the accommodation to be homely and welcoming. There is an adequate provision of shared use facilities such as lounges, bathrooms and toilets. Service users say that they have all the facilities they need in their bedrooms in order to make them into the bed-sitting areas envisaged by the Standards. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 16 Also, they say that staff have encouraged them to make them into their own private spaces. The Inspector saw evidence of this when, by invitation of the occupant, he visited one of the bedrooms. He noted that the service user concerned had elected to bring some of her own furniture into her room. Also, there were other things such ornaments and pictures which reflected her preferences. There are various items of equipment in place to support care workers when assisting those service users who experience a measure of reduced mobility. These include two mobile hoists and other smaller aids. Care workers told the Inspector that they have sufficient resources to hand to enable them to undertake safely and reliable this aspect of their work. A range of practical steps have been taken to help ensure the safety of the service users. This includes common sense but very important facilities such as the fitment of banister rails along all of the corridors. However, most of the radiators have not yet been fitted with guards which when in place should reduce the chance that someone might be burnt accidentally in the event of a fall. The Registered Provider said that she plans to resolve this omission by 1 January 2006, this being the timescale for the development which was agreed previously with the Inspector. Service users say that the accommodation is kept clean and orderly without being fussy. The Inspector’s assessment was consistent with this view. The Registered Provider said that the kitchen continues to comply with the principal requirements of the local Department of Environmental Health. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. There is an adequate number of staff on duty to ensure service users’ needs for assistance are met. With one omission, appropriate steps are taken to ensure that only suitable people work in the Home. Care workers have the competencies they need in order to work effectively. EVIDENCE: The staff roster indicates that there are at least three care workers on duty from early in the morning until the mid evening period. At this point, the two waking night care workers come on duty. During the day, there are also other people on duty who do most of the catering or most of the housework. All of the staff posts in the Home are filled. There are various arrangements in place which are designed to ensure that care workers coordinate their activities. These include handover meetings at the beginning and end of each shift. Also, diary records are completed so that each service user’s changing needs can be identified and met. Service users say or indicate that they receive all the assistance they need from care workers and that this is provided in a timely manner. The Inspector observed instances when a service user operated the call bell. He noted that a care worker was quickly in attendance. Care workers consider the Home to be adequately staffed. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 18 The Registered Provider completes a number of security-related checks. These are designed to ensure that all members of staff employed in the Home are suitable to be entrusted with access to service users who may be vulnerable. The Registered Provider is going to strengthen a particular administrative aspect of the checks made. This development will be completed before the next staff appointment is made. The Registered Provider ensures that all new care workers receive introductory training. This is designed to ensure that they have the competencies necessary to enable them to support service users effectively. In addition to this, existing care workers undertake a number of training courses which are designed to enhance their capacity to deliver care. The Registered Provider is going to complement this system by assessing the core competencies of all the care workers currently in post. This will be done by using an appraisal form which has been developed from a model that has been adopted by the Standards. The Registered Provider will complete this exercise by 1 January 2006. There are 21 care workers employed in the Home. Three of them have acquired a National Vocational Qualification (NVQ) in the delivery of personal care. The Registered Provider intends to ensure that the proportion of care workers who have completed the Award increases to approximate the 50 recommended by the Standards. The Inspector observed care workers when they were assisting the service users. He noted this help to be delivered in an appropriate manner in that the care workers demonstrated that they were competent to respond effectively and reliably to the requests for assistance in question. Also noted, was the fact that the care workers were kind and considerate in their approach. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37 and 38. There is a suitable management system in place to support the delivery of care and accommodation services in the Home. Service users’ preferences and wishes are reflected in the day to day operation of the Home. Service users’ financial interests are safeguarded. The work completed by members of staff is suitably supervised by senior staff. Service users’ best interests are safeguarded by the way in which policies and procedures are used in the Home. There is an omission in one aspect of the arrangements used to ensure the health, safety and welfare of service users. EVIDENCE: There is an established management team in the Home. This comprises the Registered Provider, the Head of Care and several senior care workers. All of these people have a detailed knowledge both of the people in residence and of Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 20 the systems used to operate the Home. There is always someone senior on the premises. Regular staff meetings are convened in the Home to help ensure that good team working is promoted. Staff say that Highland House in general is a happy place in which to work and they consider that this is noticed by the service users. Some of the service users told the Inspector that they have indeed noticed this and that they find it be reassuring to know that staff get on well together. Service users say that the Home is run without there being any intrusive rules or routines. This means that they can continue to experience a normal home life of their choosing. The Registered Provider operates a system by means of which service users are invited to comment about their Home. The Inspector noted that the results of this annual consultation exercise are summarised in a Quality Report. This indicates that a high level of satisfaction with the facilities and services provided in the Home was expressed this year. Some of the service users have asked the Registered Provider to assist them with managing their personal spending monies. There are suitable arrangements in place in relation to this matter, including a record of all the various transactions involved. Each person who works in the Home reports to a senior member of staff. This means that their work is monitored in order to ensure that it meets service users’ needs and that it contributes to the orderly running of the Home. The Registered Provider maintains various records in the Home, including those required by the Regulations. Most of these documents are in place to help to ensure that service users receive reliable and consistent assistance. The Inspector noted a number of examples of care workers organising their work in accordance with a selection of these documents. Other of the documents focus upon events such as accidents involving service users. The Inspector examined this record in particular. He did not identify any patterns which might indicate anything out of the ordinary that needed further investigation. The Registered Provider said that all items of equipment in use in the Home remain in good working order and that they have been serviced in accordance with the manufacturers’ instructions. The Registered Manager said that the premises continue to comply with the principal requirements of the Kent Fire and Rescue Service. The Inspector examined the programme of the periodic checks which have to be completed in order to ensure that the Home’s fire safety equipment remains operational. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 21 Things were found to be order. The Inspector spoke with a number of members of staff about their awareness of how best to prevent the occurrence of a fire safety emergency and how to respond effectively to one should the need arise. He noted them to have a satisfactory knowledge of the subject. The Registered Provider is going to strengthen further an aspect of how this aspect of competency is validated and recorded. This development will be completed by 1 November 2005. The Registered Provider said that she has completed a review of the premises in order to identify any potential hazards which might compromise the health and safety of both the service users and members of staff. She reported that no such hazards were found. The Inspector examined various parts of the premises and he did not notice any obvious hazards which required attention. Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 3 Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation None Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard None Good Practice Recommendations Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent. TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highland House H56-H05 S23450 Highland House V244503 041005 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!