Inspection on 13/06/06 for Homewood

This inspection was carried out on 13th June 2006.

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

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

Other inspections for this house

Homewood 10/12/07

Homewood 13/02/06

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Homewood 15 Shakespeare Road Worthing West Sussex BN11 4AR Lead Inspector Ms B Tye Unannounced Inspection 13th June 2006 08:30 Homewood DS0000064915.V294853.R01.S.doc Version 5.1 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 Homewood DS0000064915.V294853.R01.S.doc Version 5.1 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. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Homewood Address 15 Shakespeare Road Worthing West Sussex BN11 4AR 07903 234457 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) Sutton Court Associates Ltd Faith Anne Hickman Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2006 Brief Description of the Service: Homewood is a care home registered for up to six service users in the category LD (Learning Disabilities 18-65 years). The establishment is a spacious converted premises situated close to Worthing town centre. Public transport services are easily accessible. Accommodation is provided over two floors and all rooms are single occupancy with en-suite facilities. The service is privately owned and the registered provider is Sutton Court Nursing Associates. Mr N Ramdin is the Responsible Individual on behalf of the organisation. Ms Faith Hickman is the Registered Manager in charge of the day to day running of the home. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 13th June 2006. Prior to the inspection, information held on file was examined including any official documentation relating to the home. Ten feedback forms from residents and relatives were received. All comments were positive and complimentary about the service. On the morning of the inspection, all residents were dressed and socialising with staff in the dining room area and garden. During the day the inspector spoke privately to all the residents, interviewed two staff and spent some time discussing the service with the manager, Faith Hickman. Three residents care files, Policies and Procedures, Risk assessments, Training files, Medication records and all Health and Safety Records were examined. In addition, a tour of the premises was undertaken. Overall quality of care was found to be very good. Administration systems were comprehensive, well ordered and up to date. This is the first inspection of 2006/2007. This is called a key inspection and will determine the frequency of visits/inspections hereafter. What the service does well: The home is well decorated with a good standard of furnishings providing the residents with a pleasant and comfortable living environment. Information held on file was up to date and in good order. Staff spoken to stated they found the management of the home to be inclusive and supportive. Administration systems were comprehensive, well ordered and up to date. Comprehensive individual plans had been developed for each service user respecting their right to choice and lifestyle. Detailed risk assessments for all aspects of the residents care have been recorded on their files. This enables them to make informed choices and promotes their independence where possible. The home has a complaints procedure in place, which has been produced in symbol form for the residents. Relaxed and confident interactions were observed between residents and staff. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 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 Homewood DS0000064915.V294853.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Prospective residents are provided with all the information needed to make an informed decision, prior to admission of the home. All residents have a detailed needs assessment prior to admission, to ensure the home is suitable. The quality of this outcome area is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: Each resident is given the opportunity to visit the home prior to admission. This gives them the opportunity to meet other residents and staff, therefore contributing to a smooth transition process. There have been no new admissions since the last inspection. Three residents care plans were examined and all contained details of preadmission assessments. This information contributes to future care planning information and ensures the home is able to fully meet the resident’s needs prior to admission. Prospective residents and their carers are provided with all relevant information to make an informed decision about the home. Residents have the opportunity to discuss their expectations and these are recorded as part of the assessment process. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 9 The inspector viewed an up to date Service Users Guide and Statement of Purpose. This is available in symbol and picture format to assist residents in understanding what the home has to offer. There have been no changes to this document since the last inspection. A contract of Terms and Conditions are provided to each resident on admission. A copy of each contract was evidenced on three residents files, all were signed by the residents. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 6, 7 & 9 Evidence of regular reviews to assess residents changing needs, was seen on individual care plans. Residents confirmed they were supported to make choices about their lives. Detailed risk assessments have been completed for each individual in respect of their needs and agreed limitations. The quality of this outcome area was good. This judgement has been made from available evidence including a visit to the service. EVIDENCE: Three residents care files were examined and case tracked. Each file contained a detailed care plans, evidence of three monthly reviews (which were signed by the resident) detailed risk assessments and behavioural plans, relevant to the individuals agreed limitations and behaviours. It was noted changes to care plans occurred as needs of the residents changed, or following a formal three monthly review. This demonstrates the care provided at the home is in line with the residents changing needs. Care plans cover all aspects of the resident’s health, personal and social needs. All plans are signed by the residents to reflect their involvement in the care planning process. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 11 The detailed information held on care files, gives staff relevant information about how to deal with behaviours appropriately, and allows informed choices to be made in supporting individuals to achieve independent living. Daily recording sheets for three residents were viewed. These detail any significant event, which needs to be handed over to other staff at shift change. In addition to care planning, this ensures consistency for residents in relation to their care needs on a day to day basis. All information seen was detailed, up to date and in good order. Providing staff with the opportunity to access information easily, as required. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12, 13, 15, 16 & 17 Details of personal development and participation in activities, is recorded on individual care plans. Each resident has relationships outside the home, which are encouraged and supported by staff. The menu at Homewood offers a range of healthy balanced meals. The quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: An activities programme for residents is devised on an individual basis dependant on need. Residents go on outings as a group or as individuals on a daily basis. Some residents attend day centres, college and organised social activities. Community activities include in visits to the library, local shops, walks to the beach, bowling, swimming and community events. The inspector noted that each activity is risk assessed in detail, in line with individuals behaviour and agreed limitations. All information is held on individual care files. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 13 Residents spoken to confirmed the staff support them to pursue a range of activities. Activities attended by the residents are recorded as part of the care planning process and on daily record sheets. A relaxed and friendly rapport between staff and residents, was observed during the visit. This demonstrates an awareness by staff of how to communicate according to the individual’s needs and behaviours. Residents confirmed that staff support them to maintain positive relationships outside the home. For example, residents have a list of family members birthdays in their files so they can be prompted to send cards. All information relating to contact is detailed and visits home are risk assessed where relevant. Minutes for the last residents meeting were examined (23.5.06) and reflected that the residents were supported to discuss any issues of concern and contribute to the decision making within the home. Menus for the home were viewed and offered a balanced, varied diet. Weight monitoring charts seen on care plans are kept up to date and specialist dietary requirements are catered for. Residents confirmed they choose what they ate each week and they all liked the food provided. Hot and cold drinks facilities are available for residents on request. Residents have the opportunity to assist staff in cooking regularly in the home and will shop and prepare the ingredients to promote independent living skills. A rota is displayed in the kitchen and bedrooms to show when each resident is due to help staff with kitchen duties. Health and safety notices are posted in the kitchen area to protect residents from hazards. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 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 the following standard(s): 18, 19 & 20 Observation, feedback and examination of the homes records showed residents receive care and support in line with their assessed needs and personal preference. Medication is stored and labelled appropriately. The inspector found that all medication administration records were in good order. A previous requirement in respect of this has now been met in full. The quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: All the care plans examined showed detailed information and action plans relating to physical and emotional needs of each resident. Observations and feedback from residents showed these needs were being met by the staff at the home. Care plans seen by the inspector held information relating to all aspects of healthcare and medication for individuals. The records were up to date and in place, which ensures good staff practice is upheld. Individual care files contained information from involved health professionals and showed residents have access to community health specialists. This Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 15 ensures all aspects of their health needs are met both by the home and wider community. Staff support individuals to access community agencies when needed and will accompany residents to appointments as required. Policies and procedures relating to all aspects of healthcare and medication administration are in place and up to date. The key worker system at the home enables residents to talk through day to day issues and contribute to any aspect of their care on a regular basis. Medication is suitably stored in locked cabinets in the staff office. On examination of medication charts, all records were found to be completed correctly. This demonstrates that staff adhere to the homes policies and procedures when dispensing and recording. The homes training records showed that staff have completed additional medication training since the last inspection. A previous requirement in respect of this has now been met in full. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 22 & 23 A complaints procedure is available to residents and their families in the Statement of Purpose and Service Users Guide in symbol format. All staff complete Adult Protection training as part of the homes staff training programme. The quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: Adult Protection policies and procedures are detailed and up to date. Staff will use these alongside County Procedures and guidelines, which are available in the staff office. The home has a detailed procedure for complaints, which is included in the Service Users Guide and Statement of Purpose, providing residents with clear information about how to complain. All complaints information is printed in a format suitable for residents to ensure they are clear about their rights within the home. The homes complaints log is supported by an up to date complaints policy and procedure. There has been one recorded complaint by a resident, since it opened. The manager responded this to appropriately, and no further action is required. Records viewed showed that residents have three monthly meetings, which provide them with a forum to talk about any issues of concern. In addition to this, the key worker system gives residents with the opportunity to talk on a one to one basis. Staff confirmed the director also speaks to the residents on a regular basis, to gain feedback about any issues arising in the home. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 17 Four residents were spoken to privately during the visit. All stated if they had a problem or complaint they would speak directly to the homes manager or the owner. All said they felt sure they would be listened to. Staff records reflected that they receive in house training for Working with Vulnerable Adults and Adult Protection This ensures they are able to meet resident’s needs appropriately, therefore reducing risk within the home. It also provides staff with clarity about reporting procedures, should suspicion of abuse arise. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 18 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 the following standard(s): 24 - 30 The home overall offered a very modern, comfortable and clean living space for residents. Residents’ rooms contain personal possessions and all those seen were clean, tidy and offered a good standard of décor. A previous requirement in respect of radiators in resident’s bathrooms has now been met. The quality of this outcome is excellent. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: There is a large modern lounge connected to the spacious dining area, with TV and stereo equipment for use by all residents. Photographs of residents on recent trips are displayed in the dining area. The dining room is adjacent to a light, brightly decorated kitchen, which residents have access to for cooking and drink making facilities (with staff assistance). Another large lounge at the front of the house serves as a quiet area for residents. Residents are responsible for cleaning their own rooms with assistance from staff. Some residents participate in cleaning the communal parts of the home Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 19 under staff supervision to promote daily living skills and provide a sense of ownership. This was observed during the visit to the home. Resident’s rooms are a good size and furnished in their individual styles with personal possessions and pictures. There are sufficient toilets throughout the building. Each bedroom has en-suite facilities. Resident’s en-suite bathrooms have uncovered radiators which pose a possible risk of scalding to the residents. The manager and owner have resolved this by switching off the heaters permanently. The home has a large, mature garden, with a grass area for residents to make use of, in the warmer weather. There are a range of activities available, including seating areas, swing ball, badminton and a football goal. One resident proudly showed where he was growing sunflowers and carrots. Residents were seen sitting out in the garden socialising. Staff training files contained Food and Hygiene and Health and Safety certificates. This training promotes good practice in respect of hygiene and reduces the risk of infection spreading throughout the home. A fire alarm and emergency lighting system is in place. Records showed these are checked and serviced on a regular basis to ensure the safety of staff and residents. A fire equipment check is due on 30/6/06. A recommendation was made in respect of a resident who refuses to close his bedroom door during the day. The manager will risk assess this in liaison with the local fire officer. All residents are issued keys to their rooms to maintain their privacy. There are now environmental risk assessments in place for the premises, which identify risk and help to reduce or eliminate hazards within the home. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 & 36 The staff employed to work at Homewood receive on going training to meet the assessed needs of the residents. Residents benefit from a well supported and effective staff team. The quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: The home provides an induction and training programme for staff members, including specialist training relevant to individuals assessed needs. Training records for staff indicated all staff have attended mandatory and specialist training. Records seen were up to date and in good order. Staff members spoken to confirmed they had undertaken an induction at the start of their employment. Their staff training records confirmed this. Following observation and discussion with the staff on duty it was evident they were competent and clear about their roles and responsibilities within the home. Staff supervision records were viewed and some were not up to date due to annual leave and staff sickness. The manager stated she was aware that staff would need to be supervised more frequently to achieve the minimum requirement of no less than 6x supervisions a year before August 2006. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 21 All staff spoken to praised the manger for her supportive and inclusive approach. Evidence of meeting minutes and feedback from staff confirmed they attend regular staff meetings, which enable them to participate in decision making processes at the home. The home currently has a full staff compliment and does not use agency workers. This provides consistency of care to residents. Feedback from residents, staff interviews and observations led the inspector to conclude that the staff functioned effectively as a team and were supported by the management in doing so. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Good practice in the home was evident. This was supported by efficient administrative systems, which promote the health, safety and welfare of the residents in respect of their assessed care needs. The quality of this outcome is good. This judgement has been made from available evidence, including a visit to the service. EVIDENCE: The inspector examined all safety records at the home including, fire records, training, food safety log, water temperatures, individual and environmental risk assessments, the accident and incident log. They were all up to date and in good order promoting the welfare and safety of the residents. Through observation, feedback and examination of care records, good practice in the home was evident. Residents in the home have their needs met effectively and care practice is supported by efficient administrative and recording systems. All care records were kept in a locked office to maintain confidentiality. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 23 To date the Commission has received detailed monthly Regulation 26 reports from the Registered Provider, in addition to any relevant Regulation 37 reports. Previous requirements have been met in full. The home has up to date policies and procedures in line with current legislation to safe guard the rights and interests of the staff and residents. A Quality Assurance is currently being undertaken, Homewood is part of a larger organisation that has standard feedback forms for involved professionals, residents and interested parties. This information is then collated to determine the quality assurance of the service. Discussions and observations confirmed staff are given clear direction in their roles and good working practices are promoted through regular staff support and a wide range of training. Overall care provision at the home is of a very good standard and the conduct and management serves the best interests of the residents and staff team. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 24 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 3 2 3 3 X 4 X 5 3 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 4 25 3 26 3 27 4 28 4 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 3 Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 25 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. 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. Refer to Standard YA24 Good Practice Recommendations To risk assess resident bedroom door being left open during the day, under advice of fire officer. Homewood DS0000064915.V294853.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Homewood DS0000064915.V294853.R01.S.doc Version 5.1 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. 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