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Inspection on 11/04/07 for King William Residential Home

Also see our care home review for King William Residential Home for more information

This inspection was carried out on 11th April 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents spoken with and those responding to the surveys were positive about the home and the care provided. Residents and visitors commented that staff were "patient" and "kind". It was clear from observation that there were good relationships between staff and residents. The residents spoken with and those who responded to the surveys were all positive about the meals provided at the home and said they were always given a choice. Visitors spoken with said the meals were of a high standard. The home provided a clean, comfortable and pleasant environment for residents. A visitor spoken with commented on the "homely" appearance and said this had influenced the resident`s choice of home. A resident spoken with was pleased they were able to bring items of furniture from their home.

What has improved since the last inspection?

Most of the requirement made at previous inspections had been met. This had resulted in improvements to care plans, the quality assurance system, staff supervision, and the protection of residents. The improvements made at the home have been reflected in the improved quality ratings for each area of this report. Six of the seven areas are now rated as `good` and one as `adequate`. The manager successfully completed the registration process with CSCI in August 2006.

What the care home could do better:

Although improvements had been made to residents care plans, the plans were variable in quality and detail. There were gaps and lack of details in some care plans so that it was not clear that residents needs were fully met. There was an induction programme in place for new staff that met the Skills for Care requirements, but there was no record available of staff progress through the induction programme.

CARE HOMES FOR OLDER PEOPLE King William Residential Home Lowes Hill Ripley Derbyshire DE5 3DW Lead Inspector Rose Veale Key Unannounced Inspection 11th April 2007 09:45 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 King William Residential Home DS0000020027.V333962.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. King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service King William Residential Home Address Lowes Hill Ripley Derbyshire DE5 3DW 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) (01773) 748841 01773 743606 www.ashmere.co.uk Ashmere Care Group Mr Gerald Poxton, Mrs Sandra R Poxton, Mrs Ann Theresa Poxton, Dr Michael G Poxton, Mr David A Poxton Gillian Wright Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (5) of places King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Ashmere Care Group is registered to provide personal care and accommodation to service users whose primary needs fall within the following categories:Old age, not falling into any other category (OP) 28 Physical disability aged 50 years and over (PD) 5. The maximum number of persons to be accommodated at King William Residential Home is 28 13th June 2006 2. Date of last inspection Brief Description of the Service: The King William Care Home provides 24-hour care for older people and up to 5 physically disabled persons aged 50 years or over. Part of the building was formerly a public house and there is a large purpose built extension. The home is situated on the edge of a Derbyshire market town with good shopping facilities and amenities available within half a mile. The home offers 22 single rooms and 3 double rooms many of which have ensuite facilities available. There is a garden that is fully accessible to residents, and a car park. Information about the home, including CSCI inspection reports, is displayed in the home and is also available from the manager or provider on request. The range of fees charged at the home range from £380.50 to £500.00 per week. This information was provided in the pre-inspection questionnaire dated 30/03/07. King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 6 hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 21 residents accommodated in the home on the day of the inspection, all aged 65 years or over. 4 residents, 2 visitors and 6 staff were spoken with during the visit. The manager and area manager were available and helpful throughout the inspection visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. A questionnaire and surveys had been completed and returned prior to the inspection and information from this has been included in the body of this report. There was a random, unannounced inspection of the home in December 2006 to assess compliance to requirements made at the inspection in June 2006. Reference to the findings of the random inspection has been made in the body of this report. What the service does well: What has improved since the last inspection? King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 6 Most of the requirement made at previous inspections had been met. This had resulted in improvements to care plans, the quality assurance system, staff supervision, and the protection of residents. The improvements made at the home have been reflected in the improved quality ratings for each area of this report. Six of the seven areas are now rated as ‘good’ and one as ‘adequate’. The manager successfully completed the registration process with CSCI in August 2006. 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. King William Residential Home DS0000020027.V333962.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 King William Residential Home DS0000020027.V333962.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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process was sufficient to ensure residents were confident the home was able to meet their needs. EVIDENCE: The Statement of Purpose for the home had been reviewed and updated since the last inspection. The Statement of Purpose included all the required information except for specifying the number and age range for residents in each category of registration. The Statement of Purpose was displayed near the main entrance and copies were seen in several bedrooms. The records of 4 residents were examined. All had an assessment carried out prior to the admission of the resident and the assessments produced by Social Services and hospital staff. Each of the records seen had a care plan produced from the assessment information. Residents and visitors spoken with confirmed that assessment had taken place before the resident was admitted. King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 9 Staff spoken with said that there was usually a review of the needs of new residents soon after admission, and that staff views were taken into account. Residents spoken with and those responding to the surveys said their needs were met at the home. Standard 6 did not apply to this home. King William Residential Home DS0000020027.V333962.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of residents generally appeared to be met, although this was not clear because of the lack of detail and gaps in some care plans. EVIDENCE: The care records of 4 residents were examined and each included a care plan produced from the assessment information. The care plans had been signed by the resident or their representative to indicate their involvement and agreement. All of the care plans seen had been reviewed monthly. Since the last inspection the manager and senior staff had introduced a new care plan format to address problems raised in previous inspections. The new care plans included risk assessments relevant to each area of the care plan. The care plans seen were variable in the information and detail included. 1 plan was written in a person centred way, focusing on the needs and King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 11 preferences of the resident, and was detailed in describing the action required by staff to meet the resident’s needs. This care plan included references to ensuring the privacy and dignity of the resident. The other 3 care plans did not include sufficient details of the residents’ personal preferences, or of the action to be taken by staff to meet the residents’ needs. For example, the care plan of a resident who was assessed as at risk of developing pressure sores did not include specific details of the equipment to be used or of the frequency of changes of position to relieve pressure. The same care plan did not include the instructions of the speech and language therapist regarding how the resident must be assisted to eat to ensure adequate nutrition and to reduce the risk of aspiration. There was no mention of the risk of aspiration in the care plan or risk assessment. There were generalised statements used in care plans, such as “requires assistance with all aspects of personal care”, without specific details of why and how assistance was to be given. Staff spoken with were knowledgeable about the care needs and preferences of residents and were able to describe in detail the assistance given to individual residents. Staff spoken with were aware of the need to ensure privacy and dignity for residents. Residents and visitors spoken with, and residents who responded to the surveys said that staff did uphold privacy and dignity. Residents and visitors commented that staff were “patient” and “kind”. It was clear from observation that there were good relationships between staff and residents. A resident with limited communication showed a very positive response to a particular member of staff arriving on duty. There were records for each resident of the input of other healthcare professionals, such as GP, District Nurse, chiropodist and dietician. There was evidence that changes in the resident’s condition were promptly responded to by seeking advice from other healthcare professionals. Nutritional assessments were carried out and monthly weights recorded. Any falls were recorded and notes were kept of the monitoring of the resident’s condition for several days after a fall. There was evidence that residents who had frequent falls were referred to their GP for further investigation. Medication in the home was stored securely. As noted at previous inspections, the storage room temperature was recorded daily and sometimes exceeded 25 degrees centigrade. The medication administration records, (MARs), of 4 residents were examined and were correctly completed. There were records of daily checks of the MARs by senior care assistants to ensure they were correctly completed. Medication received into the home was recorded on the MARs. Medication disposed of was recorded separately and was signed by 2 members of staff and by the pharmacist. 2 of the care plans seen gave details of medication to be given ‘as required’, but did not specify when and why the medication was to be administered. King William Residential Home DS0000020027.V333962.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range of activities and standard of meals offered was good so that the lifestyle in the home met the expectations of residents. EVIDENCE: There was a range of activities offered to residents, including entertainers, skittles, bingo, crafts and dominoes. Residents and visitors spoken with had enjoyed trips out and theme evenings held at the home. There was a monthly church service held at the home. Records were kept of activities residents had taken part in, and also when residents had declined to join in. The notes of residents meetings showed that activities were discussed and ideas sought from residents. Staff spoken with were enthusiastic about activities. On the day of the inspection visit residents were occupied in activities including colouring, helping to set tables, knitting, reading a newspaper, and watching television. Visitors spoken with said they were always made welcome and were able to visit at any reasonable time. Visitors said they were encouraged to join in with King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 13 trips out and with events held at the home, such as a recent pea and pie supper. Residents spoken with said they were able to get and go to bed when they wanted to, within reason. 1 of the care plans seen included the preferences of the resident regarding daily routines, the other 3 did not have sufficient information. The residents spoken with and those who responded to the surveys were all positive about the meals provided at the home and said they were always given a choice. Visitors spoken with said the meals were of a high standard. One resident was pleased that they could choose to eat in their room if they wished. It was observed that a resident needing a pureed diet was served with a dish with all the meal pureed together, rather than keeping separate tastes and colours of the food. King William Residential Home DS0000020027.V333962.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were satisfactory policies in place and good staff awareness so that residents were protected and their concerns effectively dealt with. EVIDENCE: The complaints procedure included all the required information and was displayed in the main entrance area of the home. Records of complaints were seen and showed that complaints were handled within the given timescale, or, if not, explanations were given to complainants. The records included the action taken and the outcome of the complaint. No complaints about the home had been received by CSCI since the last inspection. At the random inspection visit in December, the policy and procedure for safeguarding vulnerable adults had been reviewed to meet the requirement made at the previous inspection. Staff training records showed that most staff had received training in safeguarding vulnerable adults and that further training was planned. Staff spoken with were aware of the procedures to follow if abuse was suspected. King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was suitably equipped and well maintained so that residents lived in a safe, clean, comfortable and pleasant environment. EVIDENCE: A tour of the building was carried out at this visit, including the communal areas, several bedrooms, the bathrooms and the laundry. The home appeared suitably equipped and well maintained throughout. The lounges were comfortably furnished. A visitor spoken with commented on the “homely” appearance and said this had influenced the resident’s choice of home. A resident spoken with was pleased they were able to bring items of furniture from their home. The home was clean throughout and free from offensive odours on the day of the inspection visit. Residents and staff spoken with said the home was always King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 16 clean and fresh. Staff were observed to use disposable aprons and gloves appropriately. Staff training records showed that most staff had received training in the control of infection. King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment practices, staff training programme and staffing levels were sufficient to ensure that residents were protected and were supported by competent staff. EVIDENCE: On the day of the inspection visit there were 3 care assistants working from 8am to 2pm, 1 from 12 noon to 8pm and 2 from 2pm to 8pm, and 2 working the night shift from 8pm to 8am. The dependency level of residents was given as 1 high, 10 medium and 10 low dependency. The staffing levels were in line with the guidance of the Residential Forum for care hours in homes for older people. In addition to the care staff, there was a cook, kitchen assistant, domestic assistant and maintenance man on duty. Residents and visitors spoken with said that there were usually enough staff on duty to meet residents’ needs. Staff spoken with said that the present staffing levels were sufficient to meet residents’ needs. Staff said that there were times when there were 2 staff on duty for the afternoon shift, but that this was manageable with the current residents. Staff said that there were sufficient staff to enable cover for sickness and holidays and that agency staff were not used at the home. King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 18 The records of 3 members of staff were examined. The records included all the required information, except for one record without a photograph. There was an induction programme in place that met the Skills for Care standards. There was no evidence available of the induction programme being completed for a recently recruited member of staff. There were individual training records for each member of staff, plus a training plan giving an overview of training carried out and training needed for the current year. Staff spoken with said that they were encouraged and supported to undertake training. 11 out of 16 care assistants had achieved a National Vocational Qualification, (NVQ), at level 2 or 3. Some staff had not received recent training in safeguarding vulnerable adults or in caring for people with dementia. There was evidence that training was planned in these areas. King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 19 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home had improved and there were good systems in place so that the health, safety and welfare of residents was promoted and protected. EVIDENCE: The manager had successfully completed the registration process with CSCI in August 2006. The manager was working towards NVQ level 4 and hoped to complete this by the end of June 2007. There were positive comments from residents, visitors and staff about the manager. Since the last inspection, the manager and senior staff had worked to comply with the requirements made. The quality assurance system had been King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 20 developed to include surveys sent out to healthcare professionals. There was no evidence of analysis of the results of quality assurance surveys or of a report to residents of the action taken to address issues raised. The staff supervision system had been revised to include discussion of care practice and personal development. Staff spoken with said that supervision now took place every other month. Records seen of staff supervision confirmed this. The random inspection visit in December 2006 found that where residents personal allowances were paid direct to the provider, the system had been revised to ensure this was paid regularly to the resident. At this inspection visit the records of residents personal money were checked. The records all had two signatures for each transaction and receipts were kept. The records were audited monthly by the manager and annually by the providers. Health and safety systems and records were sampled. Records of fire drills and checks of fire systems and equipment were all up to date. Records of the maintenance of the water system and checks of water temperatures were up to date. Accident records were completed and were stored in accordance with the Data Protection Act. There was a monthly audit of accidents. The home had current gas safety and electrical safety certificates. King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 21 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 4(1)(c) Requirement The Statement of Purpose must be amended to ensure that it meets the requirements of Schedule 1 so that residents have all the information they need to make a decision about living in the home. Previous timescales 30.11.05, 31/03/06 and 31/12/06 All residents must have a detailed care plan. This will ensure that residents receive person centred support that meets their needs. Where medication is prescribed ‘as required’, details of why and when the medication is to be given must be included in the resident’s care plan. This will ensure residents receive correct levels of medication. Records of staff induction must be available to ensure that staff are trained to National Training Organisation standards and are competent to meet the needs of residents. Timescale for action 09/05/07 2. OP7 15(1) 31/05/07 3. OP9 13(2) 31/05/07 4. OP30 18(1)(c) (i) 31/05/07 King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP15 OP33 Good Practice Recommendations Measures should be considered to ensure the temperature of the drug storage area does not exceed 25 degrees centigrade. Pureed meals should be presented in a more attractive and appealing way. An annual report should be available to residents / their representatives of the findings of quality assurance surveys and the action taken to address issues raised. King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 King William Residential Home DS0000020027.V333962.R01.S.doc Version 5.2 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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