Inspection on 13/02/08 for Holmwood

This inspection was carried out on 13th February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmwood 09/02/09

Holmwood 25/01/07

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Holmwood 11 Harvey Lane Norwich Norfolk NR7 0BW Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 13th February 2008 09:30 Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood Address 11 Harvey Lane Norwich Norfolk NR7 0BW 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) Baytree Community Care (London) Limited info@careholm.co.uk Vacant Care Home 32 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (26), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (2) Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2007 Brief Description of the Service: Holmwood is a care home registered to accommodate a maximum of 32 persons, but is currently offering only 30 places as some rooms that were originally for double occupation are now being occupied singly. Of these places 26 are for persons who fall within the category of Mental Disorder, with 4 places offered to persons who have Learning Disabilities. The premises occupy a sloped site in a residential eastern area of Norwich. There is a small parade of shops, pubs and access to the riverbank all within walking distance. There is a bus service into Norwich that passes close by. The main house is a former period residence, with accommodation for 24 service users on 3 floors. A purpose built annex, known as the Lodge, was added some years ago and offers 6 en suite single rooms with an adjoining kitchenette, lounge and bathroom. There are two lounges in the main house along with a dining room. There is a small terrace with a seating area but the garden consists of mainly trees and shrubs. The main house is approached by a sloped driveway leading to a small car park to the side of it. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. This was an unannounced inspection that took place over seven hours. The services are judged against outcome groups, which assess how well the provider delivers outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, the home’s Annual Quality Assessment Documentation, information from the service users, relatives and others who have contact with the home. The fees range from £315 to £385 per week. What the service does well: What has improved since the last inspection? Some areas of the home have been re decorated, two new washing machines have been installed and the garden has been tidied and made more open. The way that medicines are transported around the home has been made safe. Staff training in a range of basic areas, such as first aid, food hygiene and abuse awareness has improved. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 6 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. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service user’s needs are assessed prior to admission; this ensures that the home can adequately meet the needs before admission. EVIDENCE: The assessment process for one newly admitted service user was examined; information was used from other agencies alongside the home’s assessment process. The documents seen preceded the admission and gave a clear picture of the needs of this person. We noted a letter of confirmation had been sent to the prospective service user stating that their needs could be met. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service user plans and risk assessments require additional detail to evidence how the home is meeting individual needs. Although minor improvements have been made to the care planning process the variable practice regarding the care planning and delivery of care means that not all service users can be sure that their mental health and personal care needs can be fully met. EVIDENCE: We examined five care plans; the prescribed care in these was very generic and was not detailed enough in relation to specific needs such as assessed mental care needs and therapeutic intervention. Other areas of detail that was lacking included, for example, one resident had menopausal symptoms and had visited the G.P. who had said to observe, but no plan of care was in place to monitor this. Another service user had a catheter in place but there was no plan of care to guide staff as how to deal with this and prevent infections from occurring. We noted that one service user had diabetes and another had seizures, but there were no care plans in place to evidence care Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 10 that had been given or how these service users were being monitored and what steps needed to be taken in an emergency. . We also noted on the daily notes that one service user had had a urine infection; no care plan was in place for this or information as to how it was treated and whether it had been resolved. None of the care plans that we examined had any indication of service user involvement, nor had they any information as to personal independence and developing this as we found no evidence to substantiate that the service users were encouraged to take risks as part of an independent lifestyle. The care plans had dates on to signify evaluation but it was not clear if the actual care had been evaluated and any changes that had taken place. The case files that we examined evidenced limited risk assessments regarding potentially dangerous behaviour. The recording on file did not adequately assess the likelihood of identified risks or action to be taken. The daily notes were not very informative and only done on ‘an odd hoc basis’ and not every day that is suggestive that some information might not be recorded. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A limited number of activities within the home mean that the service users do not have a range of opportunities to participate in meaningful and stimulating activities. The mealtimes appear to be a social occasion and well managed. EVIDENCE: The manager and staff described the educational and social activities that are undertaken by the service users. Some of the service users attend a variety of groups and also pursue their own leisure interests. One resident told us about all the activities and groups they belong to, which included keep fit, cooking, and various educational courses. Another service told us how he enjoyed the music sessions that they had every three weeks. Some of the service users are not able to take part in group activities and would be more ably assisted with one to one activities; however it would appear that more Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 12 activities of this description could take place if the carers were not so involved with cooking and other domestic duties. One service user explained that they would like to be able to do more in house cooking but the oven that was at their disposal had not been working for some time although they had reported it on a number of occasions. We observed lunch being served and all the service users that we spoke with commented on how they enjoyed the food and that there were always plenty of choices. On the day of inspection we noted three different choices of food being offered two meat dishes and fish, the service users were also offered bread and butter pudding, fruit or yoghurt. It all looked very appealing and nutritious. This food was cooked by a member of the care staff as no designated cook is employed. The service users, as a result of a survey, now have an extra snack at nighttime. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It is not clear because of lack of recorded evidence that the service users are supported in the way they say they are or in the way that they prefer; this means that there physical and emotional needs may not be met. The anomalies that exist with the handling, administration and recording of medication puts the service users at risk. EVIDENCE: We discussed with a number of service users about the support they received from the staff, those we spoke with all felt that they were well supported by the staff in the way that they prefer: however there is lack of detail in the care plans to suggest this. For example those service users who require assistance with general hygiene and general care in relation to their mental health needs have no records in place to outline the support that they are given. The service users are able to access their GP’s when they require and one service user told us “if I need to see my G.P. the staff organise it as nothing is too much trouble for them”. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 14 After examination of care records and medication records it would appear that one service user self medicates albeit in a most unsafe manner. This particular service user had been given Co -dydramol to take when required; no record was made of how many they had been given at any given time although it would appear they had been given 100 hundred tablets. Although a risk assessment of sorts was in place it was not detailed enough, it had no date for commencement, no evaluation and no record of amounts given or not given: this service user did not have a lockable cupboard in the room for this purpose. A care plan was not in place for this ‘as required’ medicine and no rationale for continued use. We undertook a random check of medication and medicine record charts. We found that for one service user it had been recorded on the daily notes that they had had two Paracetemol tablets but these had not been recorded in the appropriate place on the medicine record chart. Although medicines are recorded on receipt in the home these are not always accurate; one service user’s medicine record chart indicated that 56 Temazepam had been received into the home, however this was inaccurate as one blister on the blister pack was totally sealed without anything in it so therefore only 55 had been received. This resulted in the records for administration of this medicine being incorrect. We did note however that the storage for Temazepam is now kept in a suitable secure cupboard for controlled drugs and a register kept of its administration. The ointments for external use that were being used did not have a date for opening on. The medicine records themselves were clearly marked and appropriate. The procedure for transporting medicines around the home has now been made safe with the use of lockable trolleys that are stored in a safe lockable room when not in use. The carer that we spoke with who was administering the medicines was seen to be carrying out the activity in a safe way; on questioning, she agreed that some training in relation to medication used in mental health conditions would be valuable as they had not received any. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for dealing with complaints is satisfactory which means that the service users can be confident that they are listened to and feel safe. EVIDENCE: Two complaints have been made to the home since the last Key Inspection both of which have been resolved in a satisfactory manner. One was in relation to missing monies that has now resulted in all service users being given lockable boxes to place valuables in. The service user concerned told us that they were satisfied in the way that the complaint had been handled and no further money had gone missing. All service users are given the home’s complaints procedure on admission to the home. Those that we spoke with said that they knew who to go if they had any concerns and one service user commented that they could tell the manager anything. The staff that we spoke with were aware of issues relating to safeguarding adults although we are aware that more accredited training needs to take place. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users do not live, or staff, work in an entirely safe environment. EVIDENCE: A tour of the premises took place and we noted that some enhancement in décor has taken place. We detected no unpleasant odours and the carpets had been cleaned. Some of the furnishings still look drab and some of the furniture needs replacing. Many of the rooms remain unclean and untidy; the caring staff often do the cleaning without any recorded input from people living in the home or support given to them to carry out this activity. The outside had been tidied and greatly improved. The manager has only been in post for five months but stated that he is aware of many outstanding areas that need to be further enhanced. Some of the towels have been replaced and liquid soap was now in all washing areas. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 17 The kitchen areas that are for use by the service users looked clean and tidy; however one oven needs to be mended and one service user stated that they would like to cook but could not because of this. They went on to sate that they had asked on a number of occasions for it to be mended. We noted that two new washing machines had been installed in the laundry room, however the walls still cannot be cleaned easily. The dishwasher in the kitchen has not worked for about fifteen months, it leaks and therefore poses a hazard; we noted tea towels being used because the dishwasher does not work, therefore it is impossible to maintain safety and cleanliness in the kitchen and thus eliminating cross infection. As there are no designated kitchen staff the caring staff prepare all the meals and spend time drying the dishes that have to be washed up by hand (see further information under the Standard for staffing). Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are not met by the numbers of staff. Service users are in safe hands, although some additional training is necessary to underpin staff practice in caring for those with mental health needs. Improvements in this area will result in better outcomes for people using the service. EVIDENCE: Discussion with the manager, staff and examination of duty rosters led us to believe that the provider operates close to minimum staffing levels. This does not allow for the dependency levels of the service users to be taken into consideration or their need for social and physical stimulation. The carers are expected to carry out a number of domestic duties including cooking, washing up and cleaning as well as their caring duties. As already mentioned previously there is no designated cook and the carers prepare all the meals including cooked breakfasts every morning; this also poses a hazard with infection control when carers are working as carers then entering the kitchen for cooking duties. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 19 Observation during the inspection process shows that several of the service users need encouragement to join activities, socialise, with eating and drinking. Given the number of service users with mental health needs, the observation of practice, discussion with staff and checking of records, the service users can be considered as being very dependent. The manager acknowledges that the many demands on the staff time affect the quality of care the staff team can deliver, despite their commitment to hard work. There is a full employment history for the new member staff and evidenced that the home has a robust system in place for recruitment, there was also evidence of induction that was related to the common induction standards. People who use the service are never involved with the recruitment of staff. There is inconsistent or inadequate supervision of staff Although some training has taken place since the last inspection this does need to be extended to ensure that all staff receive training for safeguarding adults and matters relating to meeting the health care of those with mental health needs. There are thirteen care staff in employment and six of these are doing NVQ level 2 training. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are marked areas of improvement in the overall management of the home; however people who use the service are being put at risk due to lack of repair to specialist equipment and lack of infection control. EVIDENCE: The acting manager has been in post for five months; there are a number of significant areas of non-compliance with the National Minimum Standards referred to in this report. The acting manager is aware of these and that a number of improvements need to take place to ensure that the home meets the criteria of the National Minimum Standards. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 21 The home has instigated a process for monitoring the quality of the service it provides, and has sought the views of all people using the service. However the results of the survey have yet to be calculated and addressed. Staff appreciated the new management style, and commented about the atmosphere being more open and transparent. Service users spoken to felt that some areas of the running of the home had improved and that the acting manager had made some improvements especially to the outside environment. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 2 30 2 STAFFING Standard No Score 31 2 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 x LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 3 3 2 2 2 2 Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 23 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 YA6 Regulation 15 (1) (2) (b) (c) Requirement All people using the service must have an up to date, detailed care plan. This will ensure that they receive person centred support that meets their needs. This is a repeated requirement. People who self medicate must have detailed risk assessments in place to ensure that they receive the correct levels of medication and that they are not put at risk. The registered person shall ensure that all parts of the home to which service users have access are reasonably practicable free from hazards and to their safety. All equipment should be must be in sound working order. The registered person shall ensure that at all times suitably qualified competent and experienced persons are working at the care home and ensure that persons employed at the home receive training DS0000067560.V359823.R01.S.doc Timescale for action 13/03/08 2. YA20 13 (2) 13/02/08 3. YA24 13 (4) (a) 13/02/08 4. YA35 18 (a) (c) (i) 13/05/08 Holmwood Version 5.2 Page 24 appropriate to the work they perform and that the service users needs can be met. 5. YA20 13 (2) All medication received into the home must be audited appropriately so that service users are not put at risk. 18 (1) (a) Staffing levels and arrangements must be reviewed to ensure that these are adequate to meet the assessed needs of the service users. Staffing levels must be adequate to allow rehabilitation of all service users. 13.2, 13.4 People who use the service must have medicines prescribed on a p.r.n. (as required) basis given to them by staff only when clinically justified and this can be demonstrated by record keeping practices. 13/02/08 6. YA33 13/03/08 7. YA20 13/03/08 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. 3. 4. 5. 6. Refer to Standard YA14 YA30 YA39 YA20 YA6 YA20 Good Practice Recommendations It is recommended that activities be recorded as part of the care planning system. It is recommended that consideration be given for the provision of better laundry facilities. It is recommended that the system for monitoring the services provided by the home be developed further. It is recommended that random audit of medication takes place. It is recommended that more records in daily notes are kept. It is recommended that all care staff have training in DS0000067560.V359823.R01.S.doc Version 5.2 Page 25 Holmwood 7. YA40 relation to medication relating to people with mental health needs. It is recommended that the home considers a more secure arrangement for storing the service users individual lockable boxes. Holmwood DS0000067560.V359823.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Holmwood DS0000067560.V359823.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!