Inspection on 15/02/06 for Kent House

This inspection was carried out on 15th February 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kent House 24/10/08

Kent House 16/10/06

Kent House 31/08/05

Kent House 17/02/05

Kent House 04/10/04

Kent House 20/10/03

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

CARE HOME ADULTS 18-65 Kent House Kent House 1 Haslerig Close Aylesbury Bucks HP21 9PH Lead Inspector Joan Browne Unannounced Inspection 15th February 2006 11:30 Kent House DS0000022984.V280540.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 Kent House DS0000022984.V280540.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. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kent House Address Kent House 1 Haslerig Close Aylesbury Bucks HP21 9PH 01296 330101 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) The Disabilities Trust Mrs Christine Wood Care Home 22 Category(ies) of Physical disability (22), Physical disability over registration, with number 65 years of age (6) of places Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 22 residents with a physical disability, two of whom are over 65. Date of last inspection 31st August 2005 Brief Description of the Service: Kent House is a specialist care home for adults with acquired brain injury. It is registered to provide rehabilitation and long-term care for twenty-two service users from various parts of the country. The Brain Injury Rehabilitation Trust, which is a charitable organisation, owns the home. The home is located in Aylesbury close to shops, pubs the post office and other amenities. The building is purpose built and was first registered in 1994. All the homes bedrooms are single with en suite facilities. There are four bungalows adjacent to the home for those service users who have greater degrees of independent living skills. They comprise of lounge and dining rooms, bedroom, kitchen area, bathroom and toilet. The home has a garden area, which is wheelchair accessible. There are seating arrangements where service users who smoke like to gather. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 15 February 2006 between 11.30 am and 16.00 pm. The lead inspector was Ms Joan Browne who was accompanied by Mrs Gill Wooldridge (Inspector). The inspection consisted of discussions with residents and staff, examination of care records and documentation, a tour of the communal areas. The recommendations and requirements from the previous inspection were discussed. Feedback on the findings of the inspection was discussed with the manager and deputy manager. What the service does well: What has improved since the last inspection? There has been an improvement in staff’s practice in the recording of medication. Staff’s competencies in the administration and recording of medication have been assessed. The in-house medication training had been updated. A daily task list checklist had been developed for day and night staff. The home has appointed a new chef and a therapy assistant. One resident is now living independently in the community supported by the staff team. The home’s Statement of Purpose had been reviewed. A space blanket policy had been developed. A dietician has been supporting the home with advice on healthy options food choices. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 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. Kent House DS0000022984.V280540.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 Kent House DS0000022984.V280540.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): EVIDENCE: Standard 2 was assessed at the previous inspection. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Standards 7 and 9 were assessed at the previous inspection. EVIDENCE: Four care plans were examined and it was noted in two particular residents’ care plans that problems/ needs identified as needing to be evaluated daily were not taking place. It is recommended that care plans be regularly monitored to ensure that staff evaluate needs daily as recorded in the care plans. Plans did not always fully describe the number of staff members needed to assist individuals with personal care also the level of encouragement and prompting they required. Risk assessments were in place but it was not evident that they were regularly kept under review. In one particular risk assessment it was noted that the section describing staff’s practice was not completed. For example, ‘the existing precautions box.’ In one particular resident’s care plan it was noted that the individual was fully continent in the day and occasionally incontinent at night. There was no continent assessment in place to support staff’s good practice in managing the incontinence at night. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 10 It is acknowledged that there was a detailed risk assessment in place for a particular resident’s verbal outburst. Two Waterlow assessments relating to indviduals’ tissue viability were examined. One assessment was dated 14 December 2004 and the other one was dated the 18 October 2003. It is recommended that a system be put in place to identify the frequency of how often Waterlow assessments should be reviewed. Tippex correction fluid was used to correct entries recorded in error also scribbled over entries were also noted. This practice must cease. Entries recorded in error should have a line drawn through and initialled by the author. In one particular resident’s care plan there were no apparent supporting documents to show that staff were holding the individual’s cigarettes. This could be perceived as a restriction of liberty and must be fully documented and reviewed regularly in a multi-disciplinary forum. It was noted in the progress notes for a particular resident dated 2 February 2006 stated that staff had observed a large bruise on the individual’s back. The entry stated that the individual described falling out the van to a member of staff. There was an accident report written on 30 January 2006. However, there was no entry recorded in the progress notes on the 30 January 2006 relating to the incident. It was also noted that the information recorded in the accident book stated that the individual’s risk assessment had been updated. It was not evident on the day of the inspection that the risk assessment had been updated. The home has agreed to forward a copy of the updated risk assessment to the Commission. It is recommended that information on individuals recorded in the accident book should inter-relate with the daily progress report. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 15 EVIDENCE: Staff encourage and support residents to take part in their preferred social and leisure pursuits in the local community. Whenever possible residents are encouraged to use public facilities as part of their rehabilitation and social reintegration programme as well as for social and leisure purposes. Staff accompany residents on shopping trips, visit to the local library, leisure centre, local cinema, theatre, pub or to the hairdresser. There are no restrictions on visiting. Visits from family members and other visitors are welcomed at the residents’ discretion. Residents choose whom they wish to see and can see visitors in their rooms in private. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 12 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 EVIDENCE: Staff ensure that residents’ privacy and dignity are respected. Residents’ wishes on rising and retiring are recorded in their care plans also the level of support that they require with personal care, moving and handling, choosing their own clothes hairstyle and makeup. Depending on residents’ individual needs the clinical and staff team provide residents with physical rehabilitation, long term care and support, neurobehavioural rehabilitation, neuropsychological and behaviour management treatments. Each resident has a weekly or daily programme depending on his or her needs and abilities. A key worker is designated to residents and time is allocated weekly for key workers to support residents or to discuss any issues relating to their care. Residents are made aware that they can have the services of an advocate if they wished to. Residents are registered with a general practitioner and have regular health checks such as dental, optician and chiropody. They have access to National Health Service (NHS) healthcare facilities. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 13 Protocols were in place for individual residents relating to seizure management and diabetes. It is acknowledged that seizure protocols provided detailed information to assist staff with handling the crisis. However, the protocols need to be kept under review and be dated. Evidence that protocols have been discussed and agreed in a multi-disciplinary forum by all professionals caring for the individuals should be fully documented to safeguard residents and staff. It was noted that staff were providing evasive treatment to residents such as, administering enemas. The manager was advised that although a staff member may be a qualified nurse, because the individual was not employed to provide nursing care to residents. He or she would need to be assessed and deemed competent by the district nurse to carry out evasive procedures. Records of competency assessments should be kept for inspection purposes. The home uses the Boots Mandrex monitored dosage system. The medication administration record (MAR) sheets were examined and there were no gaps noted. However, some inconsistencies were noted for example, it was not evident that a handwritten entry recorded on the MAR sheet was checked and signed by two staff members. There was a printed recorded entry on the MAR sheet for a particular resident to have ‘Fletchers Phosphate enema’ as directed. There was a handwritten amendment recorded on the MAR sheet relating to the administration of the enema with the following instructions: ‘twice a week unless condition changes.’ The entry did not appear to be countersigned by a second member of staff. It is acknowledged that the home has a system in place to record changes to the frequency and dosage of medication. However, the system needs to be improved further to ensure that information recorded could be easily tracked. Numbering the pages or bringing forward any current information could improve the system. It was noted that one particular resident was on Warfarin treatment daily. The practice in place was for a member of the senior staff to copy the daily dosage of the Warfarin from the yellow book on a sheet of paper. There was no evidence that the information recorded was checked by a second member of staff. It is recommended that two staff members should check and sign entries recorded on the sheet. Whenever possible, a printed copy of changes in the daily medication treatment of Warfarin medication should be faxed to the home. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 14 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 EVIDENCE: The home has a complaints procedure in place. A copy of the procedure was displayed on the notice board. The Commission has not received any complaints about the service since the last inspection. The complaints folder was accessible during the inspection. There were no complaints recorded since the last inspection. Staff spoken to were aware of the procedure and how they should respond to any complaints made by residents or relatives. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 15 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, 25, 29 &30 EVIDENCE: The location and layout of the home is suitable for the client group. Residents’ bedrooms consist of single occupancy and provide a bed, table, chest of drawers and comfortable chairs. Some furniture, curtains and carpets in the home had been replaced and were of a good standard. The floor covering in the dining room area had been replaced with a wooden floor and work was in progress to replace the floor covering in other areas of the building with wooden floor covering. On the day of the inspection the home was bright, cheerful, clean and free from offensive odours. Residents’ bedrooms were personalised with personal furniture, family pictures and mementos that reflected their individual characters. Residents were provided with the specialist equipment they required to maximise their independence. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 16 There were adequate numbers of washing machines and driers provided with the specified programming ability to meet disinfection standards. The laundry room was clean and tidy. It was noted that some residents were provided with washing machines in their bedrooms as part of a therapeutic programme of rehabilitation. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 17 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): 32, 34, 35 & 36 EVIDENCE: A competent and committed staff team supports residents. All senior staff have achieved National Vocational Qualification (NVQ) in level 3 and 4. Other staff were working towards achieving NVQ at level 2. Fifteen staff files were examined and there was evidence that POVA ‘first’ and Criminal Record Bureau (CRB) clearances had been obtained. However, some weaknesses in the recruitment procedure were noted. For example, it was noted that a staff member had commenced work on the 21 September 2005 but a POVA first check and CRB clearance had not been obtained until the 23 November 2005. This was discussed with the manager who explained that the particular member of staff had been issued with a CRB clearance certificate within the last month of joining the organisation and the organisation’s human resource department advised her that the certificate was portable. She has since been made aware that CRB certificates are no longer portable since the 26 July 2004. There were two written references in place for individuals but in most instances references were not from individuals’ most recent employers. As a result there was no written verification as to the reasons why individuals who were working with vulnerable adults had ceased to work in that position. Gaps in employment record were noted in one particular staff member’s record. It is acknowledged that the manger contacted the Commission the following day with an explanation from the individual relating to the gaps in Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 18 employment record. It is being made a requirement that references from previous employers must be obtained. References need to be followed up by telephone calls if necessary and must have an official stamp, or supported by a compliment slip or headed letter paper. The home has a training plan in place and all staff receive structured induction training. Inspectors had the opportunity to meet with a member of staff who was undergoing her induction programme. She confirmed that the induction programme was quite detailed to enable her to understand her role and responsibilities. She also felt that the manager and staff team had made her feel welcome. The manger has agreed to forward to the Commission a training matrix of all training that was being provided. Staff confirmed that there is a supervision and appraisal framework in place and they regularly receive one to one supervision. A schedule list of dates of supervision for staff was displayed on the staff notice board. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 19 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, 38, 39 & 42 EVIDENCE: The manager is a registered general nurse and has completed the registered managers award in care and management. She has fourteen years experience in management of clients with acquired brain injury. Her job description allows her to achieve the home’s overall aims and objectives. She is expected to keep within the home’s allocated budget. She regularly undertakes training and development meetings to update her knowledge skills and competence. The home’s certificate of registration was displayed in the home along with the employer’s liability insurance certificate, which was current. Residents are issued with written contracts and statement of terms and conditions of occupancy that are regularly reviewed. Residents’ benefit from a strong management approach of the home, which is open and positive. The manager and her senior team communicate a clear Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 20 sense of direction which residents and staff respond to and can relate it to the aims and objective of the home. Monthly staff meetings are held and staff are given the opportunity to contribute and make suggestions. Staff are aware of the organisation’s commitment in promoting equal opportunities. The home has an annual development plan in place, which is reviewed yearly. Once a year the organisation sends out questionnaires to residents, relatives and referrers to find out if they are satisfied with the service delivery. 86 of residents said that they were satisfied and 14 said that they were dissatisfied. 85 relatives were satisfied and 15 dissatisfied. 96 of referrers were satisfied and 4 dissatisfied. Overall residents were more than satisfied with the standard of cleanliness. The organisation is always please to receive feedback in any form as it helps to improve on the service delivery. Monthly Regulation 26 visits to the home by a senior member of the organisation take place. A written report is submitted to they Aylesbury office of the Commission. The health and safety records at Kent House are well managed. Showerheads are cleaned monthly. Records available indicated that the temperatures in hot water taps are regularly checked and were within satisfactory range. The fire panel is checked weekly. The emergency lights are checked monthly. Quarterly fire drills take place. There was evidence that the boiler and central heating system and hoists service records were up to date. Servicing took place on the 13 October 2005 and 25 November 2005 respectively. There was an up to date fire risk assessment for the building. The yearly portable appliance test (PAT) for all electrical equipment used in the home was carried out on the 23 April 2005. Generic risk assessments were in place and COSHH data sheets for chemical solutions and substances used in the home. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 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 X ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 2 X Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 22 Yes 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 13(2)(b) Requirement Timescale for action 31/03/06 2. YA6 13(4)(c) 3 YA6 10(1) 4 YA34 19(1) Schedule 2 The registered manager must ensure that risk assessments are fully completed and kept under review. The registered manager must 31/03/06 ensure that residents identified with continence problems need to be assessed to support staff’s good practice. The registered manager must 31/03/06 ensure that tippex correction fluid and scribbled over entries in care plans is ceased. The registered must address 30/04/06 weaknesses identified in the home’s recruitment procedure. 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 YA6 Good Practice Recommendations It is recommended that the registered manager should ensure that care plans are monitored and evaluated appropriately. DS0000022984.V280540.R01.S.doc Version 5.1 Page 23 Kent House 2 YA6 3 YA6 4 5 YA6 YA19 6 YA19 7 YA20 8 YA20 It is recommended that the registered manager should ensure that entries recorded in the accident book relating to incidents sustained by residents should inter-relate with the daily progress report. It is recommended that the registered manager should ensure that issues, which can be perceived as a restriction of liberty, are supported by documents. They should also be reviewed regularly in a multi-disciplinary forum It is recommended that the registered manager should develop a system identifying how often Waterlow assessments for residents should be reviewed. It is recommended that the registered manager should ensure that seizure protocols in place should be dated and kept under review. Evidence should be available to substantiate that protocols have been discussed and agreed in a multi-disciplinary forum. It is recommended that the registered manager should ensure that staff who perform evasive treatment to residents are assessed and deemed competent. Records of competency assessments should be kept for inspection purposes. It is recommended that the registered manager should ensure that handwritten entries recorded on MAR sheets should be checked, dated and signed by two staff members. It is recommended that the registered manager should ensure that whenever possible a printed copy of changes to Warfarin dosage is faxed to the home. Kent House DS0000022984.V280540.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Kent House DS0000022984.V280540.R01.S.doc Version 5.1 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. 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