Inspection on 20/08/07 for Holland House

This inspection was carried out on 20th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Holland House 22/08/06

Holland House 06/04/06

Holland House 08/09/05

Holland House 20/07/05

Holland House 16/11/04

Holland House 13/05/04

Holland House 05/01/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Byars Care Home

St Marys Nursing Home

Jubilee Villa Care Home

Bramble Lodge

Parkmanor Residential Home

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

CARE HOMES FOR OLDER PEOPLE Holland House 35 Church Street Market Deeping Lincs PE6 8AN Lead Inspector Kathryn Emmons Unannounced Inspection 20th August 2007 10:30 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 Holland House DS0000002373.V348903.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. Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holland House Address 35 Church Street Market Deeping Lincs PE6 8AN 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) 01778 345677 www.countrycourtcarehomes.com Mr Abdulaziz Alykhan Kachra Mrs Wendy Dellaway Care Home 21 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (21) of places Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No one falling within category OP to be admitted into Holland House Care Home when there are 21 persons within this category already accommodated within the home No one falling within category DE(E) to be admitted into Holland House Care Home when there are 3 persons within this category already accommodated within the home Service users admitted under category DE(E) should only be accommodated in the main home and not in the building know as The Barn. The maximum number of persons to be accommodated within Holland House Care Home is 21 22nd August 2006 Date of last inspection Brief Description of the Service: Holland House is registered to accommodate 21 service users, and is situated in the centre of Market Deeping. It is a large detached stone built property, and is a Grade 2 listed building. The main part of the building accommodates 15 service users and a second unit called The Barn can accommodate 6 service users. Accommodation is located on two floors of the three-storey building. Ground floor accommodation comprises a sitting room, dining room, kitchen, laundry, an office and three bedrooms, one of which is shared. There is also a bathroom and toilet. The first floor is accessed by stairs or lift, and comprises nine bedrooms, two of which are shared, and a bathroom and three toilets. There is car parking to the side and rear of the property, accessed by a gravel driveway, and the rear gardens are laid to lawns. At the time of the visit fees per week were form £335 - £435 per week. Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A visit to the service took place on August 20 2007. This visit was unannounced and took place over 5 hours. Care received by three residents was looked at in detail. This is a method called case tracking. This included looking at their personal records, a range of general home records and staff detail records. Residents were also spoken to including those whose care was not looked at in detail. Staff were spoken with and the care they provided was observed. Six residents and one relative completed comment cards at the time of the visit. We also received a completed self audit document completed by the manager to provide information before we did a site visit. We spoke with 7 residents during the visit to discuss their views of the home, and observed the care given to two other residents. We also looked at how the provider makes information about their service, including CSCI reports available to prospective service users. Residents made comments such as ‘its lovely here” and “I’m looked after very well I wouldn’t want to go anywhere else” and “they are all lovely the ones who look after you”. Other comments made by residents and staff can be seen in the main body of the report. What the service does well: Residents receive letters after their initial assessment to confirm their care needs can be met at the service. Residents have access to a wide range of healthcare processionals such as Doctors, community nurses, chiropodists and optician. Medications are stored and administered safety to ensure residents well health is maintained. A comprehensive activities programme is in place and this provides varied activities for all residents. Since the last inspection an new occupational and physiotherapy programme has started. This enables residents to become more independent and have more opportunities to improve their abilities and health. Staff are safely recruited and a comprehensive training and supervision programme enables residents to have confidence that they receive a good quality of care. The environments of the service is due to be upgraded and work had already been completed on the smaller unit and this is completed to a high standard. The service is managed by Mrs Wendy Dalloway who is an experienced manager and leads a well motivated and enthusiastic team of care and ancillary staff. Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 6 The service has commenced a new programme of self-auditing including weekly visits from the provider’s representative and from September monthly visits from another representative who will be producing written reports regarding the running of the service. There is also a self-audit questionnaire given to residents, staff and visitors, which informs the service equality assurance programme. 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. Holland House DS0000002373.V348903.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 Holland House DS0000002373.V348903.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): 3,4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Through pre admission assessment systems residents can be confident that their assessed needs can be met when they are admitted to the home. Up to date information enables residents to make an informed choice regarding living at the service EVIDENCE: The service has two up to date documents, which inform prospective residents and visitors of the service they can expect at the home. These documents are called the statement of purpose and service user guide; these were on display in the main foyer of the home along with the most the most recent inspection reports. Residents spoken to said they knew information was in place about the home as they had copies in their bedrooms. These were seen during a tour of the service. Through case tacking it was evidenced that residents had Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 9 contracts in place, which inform them of the service they could expect. Written confirmation was seen in care files that residents had be assessed prior to being admitted to the home and had been written to by the manager confirming their needs could be met.. The manger was able to give examples of the kind of care and needs residents living at the service may have and was also clear that if care needs were to complex then a placement may not be offered at the service. The home offers respite care but does not provide intermediate care. Holland House DS0000002373.V348903.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 good. This judgement has been made using available evidence including a visit to this service. Residents are treated with respect and their dignity is maintained. They are protected by the homes medication systems and their care needs are made known by clear written records. Systems in place provide access to health care professionals. EVIDENCE: All of the residents have a care plan in place. The ones we looked at showed that the resident or their relative had been involved in producing the plan and there are monthly reviews, which were used to update the plan. The information in the plan was in enough detail for the support to be given in a safe way. A key worker is named for each resident and they write a progress report. The frequency of these reports varied from monthly to 3 monthly. For equality the frequency should be determined for all residents. Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 11 Residents spoken with said they saw the doctor when they needed to and we saw from care records that the optician had recently visited the service. From reading care records and talking with residents we were told that the district nurse comes to the home to provide nursing care when this is needed. Senior staff have received training in managing medication and residents told us they were satisfied with how their medication was given to them and looked after by the home. The deputy manager told us and we saw in the care records that assessments had been carried out to assess if residents could look after there own medication. The deputy manager told us they are responsible for ordering all medication and keeping records on the stock levels and making sure medicines are returned to the chemist when no longer needed. Daily record sheets which are signed when medication have been given were looked at and had been completed correctly. A policy to follow regarding all aspects of medication kept in the home was on display and the member of care staff spoken with said they had read this. There was a certificate in staff records, which showed medication training had been carried out. Residents told us they were treated with respect and a couple made comments such as “they knock on my door and “they always speak to me in a nice way”. A carer was seen assisting a resident with their lunch in a discreet manner and another was seen to knock on a resident’s door and wait before entering. Residents were seen to be spoken to in an appropriate and valuing manner. Holland House DS0000002373.V348903.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 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have control over their lives within the service and have a full and varied activities programme in place. Their dietary pretences are catered for and they are empowered to make decisions regarding how they spend their time at the service. EVIDENCE: Residents spoken with said that they felt they were given choice over all aspects of their life they gave examples of choosing when they went to bed, when they got up, where they took their meals and what visitors they saw. The residents confirmed and minutes were seen that residents meetings took place. Residents said that any issues they raised were addressed and they were informed of any changes to the care they received or practices within the home. Two residents spoken to said they received religious support in the home and monthly a service was held for those who followed the Roman Catholic faith Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 13 and Church of England faith. The manager said that staff had received training on equalities and diversity and the policy was in place for staff to read, One of the staff spoken to did not have English as their first language and was from over seas, They said they had been supported to work in the home and that staff and residents acknowledged the care staffs nationality and there had been no issues with working in the home. Activities are in place and staff support residents with group outings, and one to one support. Events also take place in the home. Recently a bingo evening, international feast night and strawberry cream tea fête had taken place. Residents who were not able to join in group activities due to frailty or a dementia condition received appropriate one to one support. Since the last inspection a Physiotherapy and occupation therapy room have been set up and a physiotherapist is providing support to the service. Currently 4 residents are using this service to enable them to be more independent and enjoy physical comfort with gentle exercises and mobility exercises being provided. Residents sad they enjoyed the food they received at the home and there was always a choice available. Relative told us that they were able to have meals in the home with their relative if they requested this. Specialised diets are catered for such as diabetic and high fibre. All of the food in the home except the bread is home made. Menus are on display on the table as a visual reminder of the day’s meals. Residents told us they were able to have snacks and drinks if they requested these. Fresh fruit was always available and residents told us they always had enough to eat. Holland House DS0000002373.V348903.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 and 18. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents are confident that their concerns will be listened to and dealt with. Safeguarding adult polices and training for staff protects residents. EVIDENCE: There is a complaints policy on display in the home and details are also in the service user guide, which all residents have in their rooms and is also on display in the main foyer of the home. Residents who completed the comment cards given out at the time of the visit and those who were spoken to on the visit all said that they know who to speak to if they had any concerns, and were confident that concerns would be listened to and acted upon. Since the last inspection one concern was raised and this was dealt with promptly and a record was in place to demonstrate this. Staff spoken to knew what to do if a complaint was made and a relative spoken with said they have never had reason to raise any issue but were sure the manager would be able to resolve any issue raised. Since the last inspection safeguarding adult training has taken place and certificates were in staff records to evidence this. Staff spoken to gave examples of what abuse meant and what action they would take if they thought abusive practice was happening. Residents spoken with by us said, Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 15 “I’m sure they wouldn’t dream of doing anything Wendy (manager)would be there like a shot”, and “I know im safe and cared for here“. Holland House DS0000002373.V348903.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): 19,20,21,23.24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in safe, clean and comfortable surroundings. The refurbishment of the bathroom would provide residents with an improved quality facility. EVIDENCE: The service is set in the high street of the market town of Market Deeping. There are landscaped grounds and those residents who are not safe to leave the home without support are protected by the security systems on the exit doors of the building and the lockable gate to the front of the home. Residents were seen to be able to move around the home freely and corridors were wide enough to use wheelchairs and move the mobile hoist around. There is adequate seating in the lounge area and ample seating in the dining room. . Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 17 The décor was of a satisfactory standard in the corridors and communal areas of the home. Three residents rooms were seen with their permission and these had all been decorated to a good standard with carpets being in good repair. The bathroom on the first floor of the larger unit would benefit from an upgrade as the hoist setting and fixtures are looking worn and aged, as is the décor. The provider’s representative and the manager confirmed that plans were in place to upgrade the bathroom. Residents said they were always warm enough in the home and that they felt their surroundings were always clean and fresh. The smaller of the homes two units has recently been upgraded and all bedrooms and communal areas contain new furniture and facilities. This unit was not occupied at the time of the visit. Pre visit self audit information sent to us showed that all safety tests had been carried out on electrical equipment and the hoists and other equipment used around the home. Fire safety arrangements were in order. This means that residents are living in a safe environment. Infection control policies and procedures are in place including safe kitchen practice monitoring form and safety equipment such as gloves and aprons and disposal bags for laundry. Holland House DS0000002373.V348903.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by a safely recruited and well trained care team. Staffing levels enable residents to be confident that they will have their care needs met in a satisfactory way. EVIDENCE: On the day of the inspection the manager was on duty with the deputy manager and another care staff, there was a cook and a cleaner also on duty for 12 residents. The duty rota shows that there are always two staff on duty with the manager working additional hours above this level. Residents said they thought there were enough staff on duty and that they had their care needs met in an unhurried manner. Staff recruitment records were looked at for three staff and these showed that staff are recruited safely and there are references, a completed application form and evidence of identification and qualifications. All staff have a criminal record bureau check and Protection of Vulnerable Adults check made before they are offered a position within the home. When new staff start work at the home they receive an induction programme during which time they learn about the polices and procedures of the home and how to provide the necessary support to the residents. Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 19 Pre inspection self audit information and discussion with staff evidenced that training had taken place for moving and handling, fire safety, first aid and food hygiene. More training is planned for the next few months and a list was on display to show this. One of the staff spoken with had completed their National vocational qualification level 2 in care and was working towards level 3. Overall 50 of the care team have this qualification and another 34 are working towards level two or above. Comment cards we received back during the visit said that staff were always around to help and when speaking to residents at the visit the views were all positive, such as “they are so lovely here” “nothing is to much trouble” “They all know what they are doing and help you as much as you need”. Staff spoken with said they thought there were enough staff to deliver care and carry out activities. One mentioned that lunch times could be quite busy but if this happened the manager would also provide support to residents. Staff spoken with were clear on their job role and were able to identify the needs of residents. They felt they received adequate training and enjoyed a good relationship with all of the residents. Holland House DS0000002373.V348903.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A manager who has a good rapport with residents, staff and visitors manages the service. Residents are protected by the services health and safety polices and procedures. The staff supervision system enables the manager to assess the quality of care delivery by the staff. Visits by the provider’s representative enable residents to voice their opinions directly and quality assurance systems show how the service is run in the best interests of the service users. EVIDENCE: The home is managed by Wendy Dalloway who is the registered manager .The manager is supported by a deputy manager who has worked in the home for 15 years. The proprietor’s representative visits the home at least once a week Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 21 and is contactable at all times. Residents spoken with know who the manager and provider’s representative are and said that the representative often spoke with them when he visited. Staff spoken to said they have a good relationship with the manager and that she was open and responsive to any questions or comments they had. We were told and we could see on the duty rota that the manager is not included in the staff numbers to enable her to undertake management tasks. Residents told us that they thought the atmosphere is the home was “nice and family like” and “lovely to be here and do what I like even if that’s nothing”. A relative we spoke with said that the manger “is always around to speak to and is always happy to take any comment you have”. The manager and staff said that the ethos of the home was for residents to make as many decisions for themselves as they could. Three residents said they felt their opinions were heard and actioned. When residents were asked about the manager they said “Wendy is lovely and kind” and “she treats us like one of her family”. A quality assurance system is in place so residents and visitors to the home can comment on how the service operates. Resident meetings are used to inform residents what action is being taken with any comments made. From next month a new providers representative will be making monthly visits to the service to produce a report on the conduct of the home, which will be included in the homes quality assurance system. The information we were given before we visited the service showed that the service looks after small amounts of money for some residents. We looked at the money records for three of the residents we case tracked and this information was correct and clear to follow. The manager confirmed that a supervision system has been set up for all of the staff and that supervision is carried out every 2 months. Staff spoken to confirmed this. Pre inspection information evidenced that polices and procedures are maintained. Records are in place at the home, which show that servicing of equipment and systems such as the fire safety system, heating system and lift are up to date. Holland House DS0000002373.V348903.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 3 3 N/a 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 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 2 x 3 3 x 3 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 x 3 x 3 x x 3 Holland House DS0000002373.V348903.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. Standard Regulation 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 2 Refer to Standard OP7 OP21 Good Practice Recommendations All residents would befit from having the same frequency of key worker entry. This would enable the service to demonstrate equality in the practice of the care team Refurbishment of the bathroom as soon as possible will benefit residents in that they will have more comfortable facilities to use. Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Unity House The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Holland House DS0000002373.V348903.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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!