Inspection on 18/12/06 for Kent House

This inspection was carried out on 18th December 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 but made no statutory requirements on the home.

Other inspections for this house

Kent House 31/03/08

Kent House 19/06/07

Kent House 11/05/06

Kent House 27/11/05

Kent House 28/06/05

Kent House 10/04/05

Kent House 02/12/04

Kent House 22/06/04

Kent House 22/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Kent House George Street Okehampton Devon EX20 1HR Lead Inspector Anita Sutcliffe Unannounced Inspection 18th December 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kent House Address George Street Okehampton Devon EX20 1HR 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) 01837 52568 01837 55280 WWW,stone-haven.co.uk Stonehaven (Healthcare) Ltd Vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th May 2006 Brief Description of the Service: Kent House is a large detached Victorian house located in the centre of Okehampton. It is registered to provide accommodation with personal care for 25 older people who may also have dementia or a physical disability. Of the twenty-one single bedrooms nine have en suite facilities; of the two double bedrooms neither do. Bedrooms are on two floors with a lift between the ground and first and a chair lift to a mezzanine. The home benefits from 3 ground and one first floor lounges. There is a small garden at the front and patio to the side of the home. The home has been under the ownership of Stonehaven (Healthcare) Ltd since 30th Sept 2002 and the management of Julie Smith since October 2006. Current information about the home: The scale of charges: £306 - £375 per week. Additional Charges are made for hairdressing, chiropody, toiletries, magazines and papers, outings, transport and incontinence products. The home’s brochure contains all information about the home. The most recent inspection report is displayed in the entrance hall. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information about Kent House has been collected since the last key inspection, May 2006. Because of concerns identified at that inspection, and other concerns raised by health and social care professionals, an unannounced random inspection took place September 2006. It was then agreed to give the home time to implement their improvement plan before this second key inspection, the date of which was known to them in advance. Prior to these two inspection visits social services, district nurses and General Practitioners were asked their opinion of the home at this time. There were 15 service users (residents) at the time of the inspection visits. The care of two was examined in detail. All parts of the home were visited, all residents were met, conversation held with staff, the newly appointed manager, her deputy and a representative of the organisation. Staff/resident interaction was observed and a visitor spoken with. Recruitment, staff training, medication, care, fire safety and accident records were examined. Some of the home’s policies and procedures were seen. What the service does well: What has improved since the last inspection? An enormous amount has been done at the home since the last key (and random) inspections. The organisation employed an advisor, reviewed the way the home was managed and has worked through its improvement plan. This has led to: • a safer and more suitably adapted environment • better assessment of resident need and planning of care • better judgement of whose needs can be met and whose cannot • an improved menu and standard of food and nutrition • more involvement by residents in the way the home is run • safer handling of medication Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 6 • a more settled staff team Each of these benefits residents who are now living in a safer, happier home with a higher standard of living. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 (Standard 6 does not apply to Kent House) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are able to make an informed choice about whether the home is suitable for them. Care needs are met following assessment and planning, but residents should be better protected by the home’s admission policy. The specialist needs of residents at the home are now better met. EVIDENCE: The care of one newly admitted resident was examined in detail. It was confirmed that written information about the home had been made available prior to admission. This information, which includes the last inspection report, is clearly displayed in the entrance hall. The description of the home is now a truer reflection of the service provided. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 9 Assessment records of a resident prior to admission were sufficiently detailed to show that the home was suitable and could meet their needs. They should then have received written confirmation of this from the manager, but did not. This has been a previous requirement; it is necessary for their protection. One potential resident was not admitted, as it was decided that their needs could not be fully met at Kent House. Safer judgements are now being made as to when the home is, or is not, suitable. The needs of residents with mobility problems are now better met through improved maintenance and the amount of equipment provided. Staff said this was a great help to them also. Large amounts of the home have been redecorated and refurbished. Design used has been that recommended for people with dementia. It is expected that this will continue. Staff training in dementia is ongoing and staff provide emotional support for residents with this condition. The relative of a very frail resident was very happy with the way staff care for her. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care is now better planned and the health and care needs of current residents are met. The handling of medication is safe. Residents are treated with respect and with full regard for their privacy and dignity. EVIDENCE: Residents said they are well cared for. The health and care needs of some very frail, long-term residents are being met. Care planning has been reviewed and staff have received training in how to plan care effectively. This should promote safer and more consistent care delivery. Plans seen showed some good detail, especially the summary, Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 11 pressure sore risk assessment and social history. Risk assessment is improved but is still not sufficiently detailed, especially regarding falls, moving and handling and nutrition. Where staff are told to ‘monitor’ it is not clear how they are expected to do this. A resident and family member confirmed that they had some involvement in their care planning. Discussion was held with the manager as to the benefit and rights of residents to plan their care. With the support of the district nursing team the health care needs of residents are being met. Records showed that routine health care, such as eye tests and foot care, is properly managed with expert advice being sought as necessary. Where the need for equipment is identified, such as seated weighing scales, the provider/organisation is arranging this. Medication was safely stored, recorded, monitored and is now diligently handled. This is a great improvement. The home’s policy needs to be reviewed in light of current legislation (Mental Capacity Act 2005) and good practice guidelines; the scope of information is too limited and it assumes no resident is expected to look after their own medicines, even when able. Staff were observed being respectful toward residents, who confirmed that they were kind and liked. (See also Standard 32). The home has a variety of sitting rooms, so there is good opportunity for privacy if desired. Each bedroom has a lock, but keeping a key is not encouraged. This should be reconsidered. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to have a fulfilled life, but automatic choice is not yet part of the home’s culture. Residents receive a nutritious varied diet and dietary health care needs are understood. EVIDENCE: The deputy manager is good at organising ‘events’ and does so regularly. The position of the home provides the opportunity for family and friends to ‘pop in’ and residents use the local shops. There is involvement in the community. Some residents recently attended a carol service at a local church. Carol singers were also invited into Kent House. A varied programme of events is displayed in the hallway. A staff member is designated to organise activities with residents. These include skittles, quizzes, arts and crafts. Residents have had the opportunity to make their Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 13 activity and food menu preferences known through recent surveys. Residents in the lounge commented on how nice it was not to have the television on all day, and were chatting together. Another said she was pleased that her Christmas lunch would be shared with a friend in her room. Residents said that they have control over their daily routine, but the home’s policies and procedures do not fully reflect this. Food options at Kent House are much improved. The menu is varied, with cooked food available at breakfast, lunch and supper. Although the main meal is set, it is with resident involvement in the menu, and always a choice of accompaniment. The chef keeps a supply of home made alternatives should this be preferred. Most produce is locally sourced and fresh. The dining room is softly furnished, domestic in design, warm and comfortable. Residents are assisted with eating as required. The manager will review nutritional risk assessments (see also Standard 7). The recording of food and drinks taken needs to be more detailed so that it can be determined if the diet taken is healthy enough. No concerns were identified about adequate nutrition during this inspection. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from the way complaints to the home are managed. Residents are protected from abuse, but this could be further improved. EVIDENCE: The home’s complaints procedure has been improved and these were seen in bedrooms, therefore openly available. Residents said they felt they could speak with the manager and staff if they were not happy and the home’s records of complaints confirmed this. In addition, there is a suggestions box in the entrance hall, plus resident meetings where opinion can be voiced. The Commission received two complaints against the home since the May inspection. These were referred to the manager for investigation. In both cases the number and workload of staff were issues identified (see also Standard 27). The manager has a satisfactory understanding of the types of abuse and staff have received training in the protection of vulnerable adults. Information is openly displayed for staff use, which is commendable. However, the Whistle Blowing policy (informing staff how to alert the appropriate authorities if they Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 15 have concerns) continues to be unnecessarily wordy; it needs to get to the point in clear, concise language. The manager must also be clear how an allegation of abuse should be handled. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, pleasant, adequately maintained and meets current residents needs. EVIDENCE: There has been extensive redecoration at Kent House. All inhabited rooms visited were in an acceptable state of repair. One corridor carpet will need replacement in the near future as it is becoming worn. Redecoration has been taken into account the specialist needs of residents with dementia. In addition, lighting has been improved, the lift and other equipment mended. There is now a usable bathroom on each floor. A newly designated room for medication storage now protects residents as it is secure and in the correct temperature. Health and safety are satisfactory. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 17 The laundry has a satisfactory standard of equipment to meet the needs of residents and staff have hand washing equipment and safety clothing for use to prevent the spread of infection. Currently the method for moving soiled linen from one part of the home to another could be improved. The manager said she is about to introduce a non-touch system for doing this. Throughout the inspection visits the home was warm, very clean, fresh and odour free. The varied sitting rooms, small but pleasant garden, outlook and features of Kent House give it a domestic feel. The home is more secure, but residents’ liberty not reduced, with the addition of a key-pad at the front door. This followed concerns raised by a visitor that she could easily enter the home without staff knowing. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of staff are appropriate to meet the needs of residents at this time. Staff are trained but competence will be proven with time. Residents are protected by robust recruitment practice. EVIDENCE: Residents and staff said, during the inspection visits, that there were sufficient staff at Kent House, but both complaints (see Standard 16) about the home were in part staffing related. The first identified a need for adequate management and care cover when the manager is not available. The second questioned whether there was sufficient staff available at weekends. Current evidence suggests that staff numbers and allocation are now satisfactory. The provider/organisation employs staff from abroad. Many were qualified as nurses in their country of origin and bring this experience with them. Locally employed staff are undertaking National Vocational Qualification (NVQ) qualifications in care. This is considered an indicator of competence. The organisation provides varied training, some delivered itself and some delivered from training organisations. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 19 There remains a question mark as to the effectiveness of the training for staff. Issues identified during this key inspection are: • The scope of moving and handling training. Staff are taught how to use hoist equipment, but do not use other aids (handling belts, slide sheets, turntables) and appeared unsure when helping a resident to stand and walk. Fire safety. When to call the fire brigade and when this is not necessary. • Recruitment at the home has been approached in a methodical and satisfactory way in accordance with regulations. This protects residents from people unsuitable to work with them. New staff have a named supervisor whilst they get used to the home. They are allowed to ‘shadow’ an experienced member of staff for a period of time. The home had recorded evidence of training for new staff. They felt their induction was satisfactory. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Kent House is currently run in the best interests of residents. EVIDENCE: All involved with the home recognise the contribution made by the previous manager. They are pleased she continues in her new role of deputy. The newly appointed manager has made a positive start, in particular sourcing information and bringing a new leadership for staff. The organisation has provided support and coaching for her from an expert advisor. The manager has started a programme of formal supervision for staff. There are regular resident and staff meetings; records from these showed the variety Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 21 of subjects discussed. There is a suggestions box. Surveys provide opinion about the home. Residents and staff now have far more opportunity to influence what happens at the home. The home has regular assessment visits, as required of any provider organisation, but these must be unannounced, which at present they are not. The approach to managing the home in the best interest of residents has much improved. This is due to changes made within the organisation then led by the manager. Some residents look after their own financial affairs. Some have money in the home’s safe keeping. The amounts for two residents were checked correct against the balance recorded. Staff are keen to do their work well; it is hoped that their numbers and deployment, training and supervision, will be maintained at levels where they can do this. The home’s standard of maintenance is much better and the assessment of general risk is assessed more effectively. There is some further room for improvement. The fire safety policy needs review; what must staff do if the alarm goes off at night? The fire authority must also be consulted as to whether a fire door is necessary to the lower floor boiler/storage area. Moving and handling policy, procedure and training need review. Falls, moving and handling and nutritional assessment needs more detail. Accidents need to be more closely monitored and care plans reviewed in response. However, no concerns of an urgent nature were noted during this inspection. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 2 Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14(1)(d) Requirement The registered person must confirm in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. Carried forward from 25th September 2006. Staff must be suitably qualified, competent and experienced to ensure the health and welfare of service users. In this case: Moving and handling training must be of sufficient value to fully inform staff how to move, assist or guide service users in every event at the home. Amended requirement carried forward from 31st. August 2006. Where the registered provider is an organisation the care home shall be visited in accordance with this regulation by – a) the responsible individual b) another of the directors or other persons responsible DS0000032744.V323828.R01.S.doc Timescale for action 20/12/06 2 OP27 12, 18 31/01/07 3 OP33 26(2) 31/12/06 Kent House Version 5.2 Page 24 for the management of the organisation, or c) an employee who is not directly concerned with the conduct of the home 4 OP38 13(4) This visit must be unannounced. The registered person shall ensure that unnecessary risks to the health or safety or service users are identified and so far as possible eliminated. This refers to: • Response to the fire alarm at night • Need for fire door on the lower ground floor • Monitoring of falls • Improved generic and individual risk assessment • Moving and handling practice 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP8 Good Practice Recommendations Risk assessment should be a more useful tool with more detail and clarity. [Especially necessary for falls and moving and handling on this occasion]. Nutritional screening should be undertaken on admission and subsequently on a periodic basis. This recommendation was met in part but that remaining is carried forward. The medicines policy should be completely reviewed and cover all aspects of medication at the home. Service users should be able to exercise real choice in all aspects of their life. Policies and procedures should make this clear. The diet of each service user should be recorded in more detail, so that it can be determined at any time if it is DS0000032744.V323828.R01.S.doc Version 5.2 Page 25 3 4 5 OP9 OP14 OP15 Kent House 6 7 OP18 OP18 satisfactory. The manager should be clear how to manage an allegation of abuse in line with the Local Authority ‘Alerter’s’ Guide. The Whistle Blowing and Abuse policies should be written with clear and precise information and in plain English, and contain contact details for the Local Authority vulnerable adults team. This recommendation was met in part but that remaining is carried forward. Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kent House DS0000032744.V323828.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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