Inspection on 10/01/06 for King Edward House

This inspection was carried out on 10th January 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

King Edward House 22/02/08

King Edward House 03/03/07

King Edward House 21/06/05

King Edward House 03/12/04

King Edward House 15/06/04

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

CARE HOME ADULTS 18-65 King Edward House 77 New Street Ash Canterbury Kent CT3 2BW Lead Inspector Mary Cochrane Unannounced Inspection 10th January 2005 09:30 King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 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 King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 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. King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service King Edward House Address 77 New Street Ash Canterbury Kent CT3 2BW 01304 812953 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) Mr Rex Slade Cadman Mr Rod-Rennie Cadman Care Home 5 Category(ies) of Learning disability (5) registration, with number of places King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two Service Users whose dates of birth are 01/03/1939 and 10/03/1930. 21st June 2005 Date of last inspection Brief Description of the Service: King Edward House is a detached property in the village of Ash approximately 10 miles from Canterbury. The home is registered for 5 people with learning disabilities. There is one member of the care staff team who lives in at the home and she is supported by 3 members of staff. King Edward House is a satellite unit of the Old Rectory, and additional staff provide cover as and when required. The accommodation for the service users consists of 3 single bedrooms and one double bedroom. There are two bathrooms one on the east side and one to the west side of the home. On the ground floor there is a large living room, kitchen with dining area and additional small lounge, utility room and conservatory area. There are large grounds that are laid mainly to lawn, with a parking area to the front and side of the property. King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection at King Edward House this year. This inspection was unannounced. The visit took place over a period of four hours between 11.00a.m and 3.00p.m. The majority of the key standards were inspected earlier in the year, so the inspector focused on the requirements and recommendation identified at the previous visit and any out-standing key standards. On arrival at King Edward House there was only one member staff at the home. The five service users were at the companies other larger home ‘The Rectory’, which is located close by. Service users regularly go to The Rectory for activities and to socialise. The senior team leader and the registered provider came to the home to assist with the inspection and they were available and helpful throughout. All the service users returned to the house at 12.00p.m for lunch. King Edward House provides a homely, relaxed and friendly environment for 5 gentlemen with learning disabilities who have all lived at the home since 1988. The senior team leader of the home lives in and staff have developed positive and meaningful relationships with all of the residents and they were seen to interact in away that was sensitive, caring and respectful. There was seen to be an understanding between the service users and staff and needs of the service users are anticipated and dealt with appropriately. The service users reported that for the majority of the time they all get on well together. They also said that they were happy at the home and were well looked after. The service users are well kept and dressed smartly and in keeping with their personalities. There was a friendly and relaxed atmosphere and people were busy, motivated and interested in the activities they were undertaking. The majority of home is well maintained and decorated to a good standard providing service users with an attractive and homely place to live. Residents of the home have a good range of activities available both within and outside the home. Health and safety documentation and records were, in general, well maintained and up to date. The staff and registered provider were very positive about the inspection process and felt it was beneficial and ’’kept them on their toes’’. King Edward House functions as a ‘real’ home for the residents. Service users and staff should be commended for attaining this. The following methods of inspection and information gathering were used: one-to-one discussion with service users and staff, observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments and selected policies and procedures. King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: King Edward House needs to have a registered manager in post that is involved in the day-to-day running of the home. The appointed registered manager does not undertake this role. This issue needs to be addressed and resolved by the registered provider. The home needs to produce a staff rota to evidence that they have enough staff on duty to meet the needs of the service users. A copy of this needs to be sent to the CSCI office. Quality assurance needs to be further developed so the home can evidence that they are meeting their aims and objectives. Since the last inspection the home has started monitoring the temperature in the bathrooms and sinks it was evidenced that in one of the bathrooms the temperature was too high. Action to rectify this was undertaken at the inspection. King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 7 The staff need to ensure that the care plans are kept up –to date to reflect the changing needs of the service users. All records including staff records need to be stored at the home and all staff at the home require infection control training and would benefit from adult protection training. It needs to be ensured that all staff receive the support and supervision they need to undertake their jobs effectively. 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. King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 8 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 King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 9 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): These standards were inspected and met at the last visit to the home in June ’05. There have been no admissions to the home in the mean time. EVIDENCE: King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 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 There is a care planning system in place. It needs to be up-dated as necessary to provide staff with accurate information on how to meet the changing needs of the service users Service users are able to make decisions about their own lives and assisted as necessary Risks are identified, recorded and minimised ensuring that service users are protected and kept as safe as possible. EVIDENCE: There are individual care plans in place for each of the service users. The inspector looked at 3 of the care plans. They reflect the individual needs of each of the service users and the action that is required of the care staff to attain this. The plans detail, personal care information, medical needs, social needs, preferences, Service User questionnaire and individual abilities. OutKing Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 11 comes and goals are also identified. Six monthly reviews have now commenced with significant professionals and each of the service users now have a named care manager. It was evidenced at the inspection that some of the plans did not reflect the changing needs of the service users. It was identified in 2 of the plans that recent identified physical needs had not been incorporated into the care plans so therefore staff had no written information and guidance available to assist them in dealing with the specific needs of the service users. The outcome of treatments was not documented and there was no evidence to show if the needs had been resolved satisfactorily. This was discussed with the senior team leader at the visit. Through observation and when speaking to the service users there is evidence to support that service users are involved in decision-making processes pertaining to their own lives. Care staff and service users were able to demonstrate how individual choices had been made and the reasons why others had sometimes made decisions. Since the last inspection risk assessments have been further developed. There are now risk assessments in place, which are individualised and provide information on how to minimise identified risks, these are of a good standard and are up-dated as required. It was evidenced at the visit that all information pertaining to the service users is kept securely at the home. The staff office is locked if it is unoccupied. Staff were seen to respect the confidentiality of the service users. . King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 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 &,14 Service users are able to maintain and develop an appropriate and fulfilling life-style both in-side and out-side the home. Accurate recording of daily activities is maintained to evidence this. EVIDENCE: From talking to the staff and service users it was evidenced that the service users do participate in fulfilling activities and leisure pursuits. Individual activities programmes are now in place, which give guidance and direction to the service users and the care staff. King Edward House interacts and shares a lot of the facilities with The Rectory, which is the larger home in the near vicinity belonging to the registered provider. Service users are able to visit each other and develop relationships. There is an activities organiser based at The Rectory and the residents from King Edward go there regularly throughout the week to participate in music groups, arts and crafts sessions amongst other things which they said they enjoy. The staff actively encourage service users to attend college courses, King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 13 develop life skills and pursue activities of their choice. All service users are encouraged to gain outside interests, some have chosen to attend college courses in computing, cookery, woodwork and arts and crafts. Others prefer to assist in the day-to-day running of the home and household tasks. The inspector spoke to the service users residing at King Edward House who confirmed that they are able to develop their individual hobbies and leisure activities. All residents had an annual holiday last year. King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 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): 19 The home provides appropriate personal and health –care for the service users they need to ensure that they accurately document any changes in the service users care needs. The other key standards were inspected and met at the previous visit. EVIDENCE: The home has a good relationship with the local G.P surgery. Medication is reviewed at regular intervals and annual health checks are undertaken. Service users health care needs are monitored closely and they are promptly referred to the appropriate specialist should the need arise. A member of staff accompanies service users when they are attending appointments. A medical report sheet is maintained by the home so as to evidence dental, chiropody, G.P. and other health care appointments. The senior staff at the home need to ensure that any changes in treatment or care of the service users is documented in the individual service users care plan. It was evidenced that on occasions when service users had visited the G.P surgery changes in treatment and care had been prescribed. This had not then been reflected in the care plans of the service users and there was no indication as to whether the treatment had been successful or whether it had been completed. This was discussed with the senior team leader at the inspection. King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 15 King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 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): These standards were inspected and met at the previous visit. EVIDENCE: King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 17 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 &28 The home is well maintained and decorated to a good standard providing service users with an attractive, comfortable and homely place to live. EVIDENCE: The accommodation provided is sufficient in space to meet the needs of the service users. The premises are safe, comfortable, airy and clean and provide sufficient light heat and ventilation. The premises are in keeping with the local community and accessible to all the service users. Furnishings, fittings, adaptations and equipment are of good quality and suitable for their purpose. The senior team leader identifies any maintenance work on a regular basis this is then assessed by the handyman and work is usually undertaken. Since the last inspection the conservatory area of the home has been repainted and new lino placed on the floor. This area is mainly used for washing and drying clothes. Service users do have plenty of adequate communal space available and tend not to use the conservatory. The area out-side the conservatory does need some attention as the ground is uneven and could present a risk to service users and staff. Also the garden does need to be cleared so that it can be enjoyed by the service users in the better weather King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 18 King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 32,33,35 & 36 The staff have a good understanding of the service users and positive relationships have been formed. The home needs to ensure the safety of the service users by providing the required training for the staff and offering them the support and supervision that they need to carry out their jobs effectively. EVIDENCE: Since the last inspection the senior team leader has left the home and an existing member of the staff team has replaced her. She is keen to develop the service for the service users at the home and has good ideas on how she is going to do this. She is presently undertaking her level NVQ4 The home also have 3 other care staff who work at the home. The new senior team leader is supported by the registered manager/registered provider of The Rectory, the deputy and other staff are also on hand to give advice, support and assistance if necessary. At the time of the visit the home was unable to produce an up-to –date staff rota. The inspector was informed that the staff always work the same shifts. The home needs to be able to evidence that they have enough staff on duty at all times to meet the needs of the service users. The inspector requested that an up-to date duty rota be forwarded to the CSCI The care staff reported that they have developed good relationships with the service users and they were able to anticipate and meet the individual needs of the client group. There are no volunteers going into the home at the present time. It was observed that the staff are accessible and approachable to the King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 20 service users and are able to exhibit good listening and communication skills. It was evidenced that the staff on duty put the needs of the service users first. At the previous inspection the inspector was able to see the staff files however at this visit the files were being stored at The Rectory (this will be discussed in the next section) so there was no information on recruitment or staff training. There was no training programme in place and no training matrix available at the home. The inspector was informed that all staff have all received mandatory training except for infection control this had been an oversight. The registered provider is going to ensure that all levels of staff receive this training. The staff would also benefit from adult protection training to ensure that all staff are aware of all the aspects of adult abuse. The inspector was also informed that the staff are not receiving regular formal supervision sessions. This needs to be implemented and a record kept in the staff files. King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 21 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 and 42 The home needs to have a registered manager in post who available and manages the home on a day-to day basis. Quality assurance and monitoring needs to be further developed to ensure the aims and objectives of the home are being met and the views of the service users/representative are acted on. The safety of the service users needs to be protected at all times. EVIDENCE: At the last inspection it was evidenced that the registered manager of the home spends very little time there and is unable to give the direction and support needed. This issue still needs to be addressed and was discussed with the registered provider at this visit. King Edward house would benefit from its own dedicated manager. However the registered provider who is also the registered manager of the larger nearby home feels that he will also be able to undertake the role of registered manager of King Edward House. This is King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 22 feasible at the moment providing the numbers and service users at King Edward remain unchanged. The registered provider needs to produce evidence and plans on how he is going to divide his time between the homes and what support systems he has in place. He would also have to undergo a fit person interview with the CSCI and continue the NVQ level4/RMA courses. This issue needs to be addressed as soon as possible to ensure that the service users benefit from appropriate management, direction, leadership and guidance. The home has some quality assurance and monitoring tools in place. Service users are given questionnaires on a regular basis where they are asked for their views on the home and the service they receive. There is no evidence to show if their views are then acted on and what the out-comes are. The registered provider and deputy manager of The Rectory did undertake an audit at the home on the 21/12/05 however they were unable to produce any written documentation about the results of the audit and the out-comes. The registered person needs to develop systems, which provide a measure on the effectiveness of the service. The home needs to be able to identify whether they are meetings their aims and objectives and develop systems for continuous self monitoring of the services they provide. Quality assurance and quality monitoring systems need to include the views of family/representatives, friends and other professionals who have input into the home. At the time of the visit none of the staff records are being stored at the home. At the previous announced inspection these records were available but they have now been removed and are kept at The Rectory. The registered person needs to ensure that all records pertaining to the home are stored securely within the home. At the last inspection it was identified that the home was not keeping a record of water temperatures in the baths and sinks used by the service users. At this visit this had been rectified and temperatures are recorded regularly. It was evidence that the temperature of the bath and sink in a service users bathroom was hotter than the recommended limit. The registered provider took immediate steps to address this. The staff need to be aware of guidance regarding water temperatures so that prompt action can be taken to rectify any problems and ensuring the safety of the service users. King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X 2 X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 2 X 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 King Edward House Score X 2 X X Standard No 37 38 39 40 41 42 43 Score 1 X 1 X 2 2 X DS0000023215.V258854.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? NO 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 2 YA33 Standard YA6 Regulation 15 (1) Requirement Timescale for action 28/02/06 3 YA35 4 5 YA36 YA37 5 YA39 The home needs to ensure that all the care plans are up- to date to reflect the changing needs of the service users 18(1)(a) The home needs to be able to produce a staff duty rota to evidence that they have sufficient numbers of staff on duty at all times to met the needs of the service users. . An up to date duty rota needs to be forwarded to the CSCI. 18(1)(c) The home need to be able to evidence that they have a training programme in place, which is on going and up-todate. All staff need to receive the required mandatory training which includes infection control 18 (2) All staff receive the support and supervision they need to carry out their jobs 8,9 The home needs a registered manager in post who is available to undertake the daily managerial responsibilities of the home. The manager also needs to working towards the NVQ4/RMA. 24(1)(a)(b) Effective quality assurance and DS0000023215.V258854.R01.S.doc 28/02/06 31/03/06 28/02/06 31/03/06 30/04/06 Page 25 King Edward House Version 5.0 (2)(30) quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 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 YA19 Good Practice Recommendations The staff need to evidence that there procedures in place to ensure the health care needs of the service users are met. Care plans need be up-dated and reviewed as necessary. The home needs to ensure that the area around the conservatory is made safe and the garden is cleared to allow service users to enjoy it in the better weather All staff would benefit from adult protection training. All records pertaining to King Edward House and the staff need to be stored at the home. To ensure that the water temperatures are maintained within the required limits. 2 3 4 5 YA28 YA32 YA41 YA42 King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 King Edward House DS0000023215.V258854.R01.S.doc Version 5.0 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. 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