CARE HOME ADULTS 18-65
Homeleigh 28 Middleton Road Crumpsall Manchester M8 4JX Lead Inspector
Steve OConnor Unannounced 28 September 2005
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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Homeleigh Address 28 Middleton Road Crumpsall Manchester M8 4JX 0161 740 7313 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) Southfield Care Homes Limited Responsible Individual - Marie Wronko Susan Bradbury Care home only (PC) 30 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) 24 of places Learning disability (LD) 1 Mental Disorder, excluding learning disability or dementia - over 65 years of age (MD(E)) 5 Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 One named person who requires personal care only by reason of learning disability is accommodated. Should this service user no longer reside at the home then the registration will revert to thirty places for mental disorder (MD). 2 Five named persons are over 65 years of age but requiring care by reason of mental disorder excluding learning disability or dementia. Should any of these service users no longer reside at the home, the registration category for these places will revert to accommodation for people under 65 years of age with a mental disorder (MD). Date of last inspection 10 February 2005 Brief Description of the Service: Homeleigh is a care home providing 24-hour care and accommodation for up to 30 adults with mental health problems. The home is a detached 3 storey building set within its own grounds. Accommodation is spread over three floors with a combination of single and double rooms and also one self-contained flat. There is a smoking and non-smoking lounge and a dinning room set out in a cafeteria style with bench seating. Within the grounds and facing the main street is a large visable signboard with the homes name and also information about recruiting staff. In addition there are large signs attached to two walls of the house regarding the recruitment of staff that can be viewed by passing traffic. The home is situated in the Crumpsall area north of Manchester city centre. It is close to local amenities and public transport links. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 28th September 2005. Time was spent talking with people, the manager, some of the staff on duty and observing how staff worked with people. In addition people’s files and other documents were inspected. A tour of the premises was also made. The previous inspection in February 2005 had identified a number of areas that the home needed to improve upon. These areas had been actioned by the home. The CSCI had received a complaint about the home since the last inspection. The complaint related to the provision of training in working with challenging behaviour. The complaint had been partially upheld and it was found that this training had not yet been provided for the staff team. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. During the inspection it was found that the company that owned and run the home had been sold. The staff had only recently been informed of the change but had already met with representatives from the new company (Regard). The areas that need improvement are identified in this report will be reported to Regard that require urgent attention. What the service does well:
The home supports up to 30 people who have long term and enduring mental health problems. Without support these people would not be able to cope on their own in the community and would be at risk of becoming ill and needing hospital admissions. The home has worked hard to help maintain people’s general and mental health and have had very few incidents of people’s mental health deteriorating. In addition, some people who have lived at the home have moved onto less supported accommodation in the community. The manager of the home was open and honest about the problems she has been facing due to a lack of investment and resources in keeping the fabric and condition of the building to a good standard. She acknowledged the importance of how having a pleasant environment to live in affects the wellbeing of the people being supported. She has regularly reported faults and the need for repairs but had no control over any budget or the work of the maintenance worker.
Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 6 The feedback from staff was very positive about the way that the manager supports them and in finding training resources to help them develop their skills and knowledge. What has improved since the last inspection? What they could do better:
An extensive tour of the building was made and the first impressions were that the home was generally gloomy with poor and out-dated decoration and that the building had suffered from a lack of investment. The list of the areas that are in urgent need of replacing, repair and redecoration is too long to repeat in this summary but generally speaking the majority of the house, including all the bedrooms, was in urgent need of decoration, the bathrooms and toilets were in a very poor condition, the dining room and other communal areas was in a poor condition, wall light fittings in bedrooms and corridors had missing covers and light bulbs and are considered unsafe, the bedrooms had poor quality, damaged and mismatched furniture, there were no safety restrictors on windows above the ground floor, the radiators in bedrooms and other areas did not have any covers and are considered as posing a possible risk to some people’s safety. It was even found that some people living at the home would often take away the toilet rolls in the toilets and someone could find themselves searching for toilet rolls because the home had not had the resources to address the problem. The responsibility for cleaning this large house was down to the staff on duty during the day. This meant that before actually supporting and working with
Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 7 people each member of staff on duty had to clean a part of the house. Although the building was generally clean, it as found that certain areas, that are difficult to reach, were dirty, had cobwebs and even dead insects present. A complaint was made to the CSCI with concerns that the home was not providing staff with training to help them cope with and support people whose behaviour may be challenging, aggressive and occasionally violent. This was investigated in April 2005 and found that the home had developed a policy and procedure for managing aggressive incidents and undertaken risk assessments but they had not been able to provide specific training due the home not having a training manager. The complaint was partially upheld and the home was required to provide the training. In addition the CSCI were told at the time that there had not been any serious incidents that staff have had to deal with. However, during this inspection staff at the home had told an inspector that they had dealt with an aggressive incident earlier in the year and the inspector had recently become aware of a violent incident that had occurred in July of 2004. During the inspection staff were spoken to about the training they had been given and it was found that the challenging behaviour training had still not been provided and a training manager not been appointed. The telephone facilities available for people to use are positioned in the corridor and so people cannot make private telephone calls. The home must make arrangements that allow people to use telephone facilities in private. Many care homes have signs outside or attached to the building that give the name of the home. Homeleigh has three very prominent signs that not only give the name of the home but are also advertising for staff. It is questioned whether the use of recruitment advertising boards on and around the building is in keeping with the aims and objectives of the home and it is recommended that the use of such advertising boards is reviewed. The home works together with each person and/or their families or representatives to agree a care plan that sets out what support a person needs and how the home is going to meet their goals and needs. Some examples of the care plans seen had vague goals such as ‘meaningful activities’ and did not go into much detail of what that actually meant. Also the home has to record what it is doing to support a person to meet their goals. The examples of the home’s recording did not contain much information about what a person actually did or how it related to the care plan. It is recommended that the individual care plans and ongoing recording accurately reflect a person’s actual goals and how the home supports people to achieve them. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 8 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. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home ensures that people’s needs are assessed and known before offering them a placement. EVIDENCE: Some examples of people’s files who had come to live at the home since the last inspection were seen and found to contain a comprehensive assessment from the purchasing authorities. These also include specific mental health assessments and risk assessments. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 The care plans reflected people’s current goals and needs but the home did not provide staff fully with the training required to respond to known risk situations. EVIDENCE: People had an individual care plan that detailed aspects of personal, social and health care needs and how their needs would be met. The plan was completed with the involvement of the person, their representative and their care manager. Care plans were reviewed on a six monthly basis. The recording to show the activities people participated in was at times very brief and did not show how the home was meeting a person’s goals. It is recommended that the individual care plans and ongoing recording accurately reflect a person’s actual goals and how the home supports people to achieve them. The home used a standard format to look at situations, events and behaviour that may cause a risk to people’s wellbeing. Once identified, the home developed support guidance for staff in how to minimize those risks. Some
Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 12 good examples of risk assessments were seen that had been agreed with the person’s care manager. However, here have been incidents where staff have had to physically intervene to prevent a person harming themselves or others or to cope with challenging behaviour. Staff must participate in training in how to work and respond to challenging behaviour. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed during this inspection. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The home supported people to maintain their personal and healthcare needs and had the medication systems in place to administer safely. EVIDENCE: People living at the home were mostly independent in meeting their personal care needs and received prompting and encouragement from the home to maintain this. People’s goals for maintaining their personal and healthcare were recorded in the person’s care plan. People’s general and mental health was supported through the staff teams knowledge of a person’s behaviour and triggers for ill health and supported people to access general and specialist healthcare providers when required. Monitoring records for specific health issues such as epilepsy were maintained. The medication administration system was found to be accurate and only staff who have undertaken the required medication training would administer medication. Controlled drugs were stored and recorded correctly. Guidance for administering medication prescribed ‘as required’ (PRN) had been developed and administering was recorded accurately. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed during this inspection. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26 and 30 The home does not provide a clean, homely, comfortable or safe environment for people to live in. EVIDENCE: During a tour of the premises a large number of concerns were identified regarding the condition of the building. Those concerns observed are listed below. It is acknowledged that despite the tour there may have been areas of decoration, repair or replacement that were missed. In addition to making good the areas identified below the home must undertake a full audit of the premises to clearly identify all the areas of the building that require redecoration, repair and replacement. An action plan must be developed and timescales set for undertaking the work required. A copy of this action plan must be provided to the CSCI within the timescales stated. In addition, the inspectors did not look into every bedroom to assess its condition. The home must undertake a full audit of all the bedrooms to establish the type, condition and standard of all furniture, fixtures and fittings and confirm whether each bedroom meets the furniture and fittings requirements of standard 26. An action plan must be developed setting out the timescales for undertaking the required work, replacement and purchase to
Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 17 ensure that the bedrooms meet the National Minimum Standards. The home must provide the CSCI with the audit and action plan within the timescale set. The areas that require making good. 1. Laundry: Floor damaged and needs replacing. Walls need repairing. The room needs decorating. 2. Corridors: All the corridor areas need decoration. Uneven floors need repairing. Stained and damaged carpeting needs replacing. 3. Kitchen: Wall tiles are missing and damaged and must be replaced. Work surfaces are damaged and must be replaced. The lighting around the cooking area is poor and must be improved. 4. Dinning Room: The carpets are in poor condition and must be replaced. The seating and tables are in a poor condition and must be replaced. The dinning room requires decoration. 5. Staff Room: Work surfaces are damaged and must be repaired. Tiling is damaged and must be repaired. There is damage to the wall around the doorframe and must be repaired. 6. Toilets: All the toilets seen were in need of decoration. All toilets required the appropriate soap and hand drying equipment. All toilets needed a system to prevent toilet rolls from being removed. All the toilets require the appropriate safety lock to allow privacy and to be overridden in the case of emergency. All missing light covers must be replaced. All damaged tiling needs to be replaced. All damaged and/or stained flooring needs to be replaced. Any damaged sanitary wear, fixtures and fittings must be replaced. 7. Bathrooms/washing facilities: The cracked sink in the bathroom/toilet on the 1st floor must be replaced. The bath in bathroom near room 2 is stained and scratched and needs replacing. The damp damage in this area needs to be repaired. The window in bathroom near room 4 is cracked and must be replaced. The bath in this room is in a poor condition and must be replaced. The extractor in bathroom near room 12 must be replaced. The bath in the same room is in a poor condition and needs replacing. The shower on the 1st floor does not work and needs repair. The shower tray is stained and sealant poor and needs repair. 8. Communal Lounges: Both lounges require the extractor fan to be cleaned and made in good working order. The carpets in both areas are stained and damaged and need replacing. All worn and damaged furniture must be replaced. Both rooms require decoration. 9. Windows: No windows above the first floor have window restrictors as required under health and safety regulations. All relevant windows must have restrictors unless the CSCI receives contrary advise from the local fire officer. The stained glass window on the 3rd floor is damaged and has had a poor repair. The window could pose a safety risk and must be made safe. 10. Light Fittings: Wall light fittings throughout the building have missing covers, light bulbs and many have exposed electrical parts that could pose a risk to people’s safety. The light fitting must be made safe and/or alternative means of suitable lighting used.
Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 18 11. Bedrooms: Some bedrooms are in need of decoration. 12. The back stair area: there is a large crack in the wall that must be investigated and made good. 13. Courtyard: Broken and uneven floor slabs must be replaced. 14. Radiators: Radiators in some areas do not have any cover to minimize the risks of injury to people. The home supports vulnerable people who could be at risk of injury from unprotected radiators. The home must risk assess each individual person for the hazards associated with unprotected radiators. All of the above must be addressed in the required action plan to be submitted to the CSCI within the set timescales. The telephone facilities available for people to use are positioned in the corridor and so people cannot make private telephone calls. The home must make arrangements that allow people to use telephone facilities in private. Staff have the responsibility for the daily cleaning of the home and to support/encourage people to become involved and maintain their domestic skills. Certain areas of the home, that were difficult to reach, were dirty and required cleaning. In the grounds of the home there is a large signboard with the home’s name and advertising for staff. There are also large adverts for staff on two walls of the building. It is questioned whether the use of recruitment advertising boards on and around the building is in keeping with the aims and objectives of the home and it is recommended that the use of such advertising boards is reviewed. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed during this inspection. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 1 x 2 x x x 2 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Homeleigh Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 22 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 9 Regulation 18 Requirement Staff must participate in training in how to work and respond to challenging behaviour. Training action plan to be submitted within the timescale stated. 1. A full audit of the premises must be undertaken to clearly identify all the areas of the building that require redecoration, repair and replacement. 2. An action plan must be developed and timescales set for undertaking the work required. 3. A copy of this action plan must be provided to the CSCI within the timescales stated. 1. All those areas identified from numbers 1 to 15 in standard 24 must e addressed and made good. 2. All the above must be addressed in the required action plan to be submitted to the CSCI within the set timescales. 1. The home must undertake a full audit of all the bedrooms to establish the type, condition and standard of all furniture, fixtures and fittings and confirm whether each bedroom meets the
F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Timescale for action 30/12/05 2. 24 23 01/12/05 3. 24 23 01/12/05 4. 26 16 01/12/05 Homeleigh Version 1.40 Page 23 5. 6. 30 24 23 16 furniture and fittings requirements of standard 26. 2. An action plan must be developed setting out the timescales for undertaking the required work, replacement and purchase to ensure that the bedrooms meet the National Minimum Standards. 3. The home must provide the CSCI with the audit and action plan within the timescale set. The extractor fans in communal areas must be cleaned. The home must make arrangements that allow people to use telephone facilities in private. 01/12/05 01/12/05 7. 8. 9. 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. Refer to Standard 6 24 Good Practice Recommendations It is recommended that the individual care plans and ongoing recording accurately reflect a person’s actual goals and how the home supports people to achieve them. it is recommended that the use of advertising boards in the grounds and on the building wall be reviewed to ensure it meets with the aims and objectives of the home. Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ 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 Homeleigh F55 F05 s21618 Homeleigh V245873 D260805 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!
