Inspection on 20/09/05 for 228 Kingsbury Road

This inspection was carried out on 20th September 2005.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

228 Kingsbury Road 06/02/07

228 Kingsbury Road 25/05/06

228 Kingsbury Road 31/01/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Kingsbury Road, 228 Erdington Birmingham B24 8QY Lead Inspector Alison Ridge Unannounced Inspection 20th September 2005 3:00 Kingsbury Road, 228 DS0000065003.V252384.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 Kingsbury Road, 228 DS0000065003.V252384.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. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kingsbury Road, 228 Address Erdington Birmingham B24 8QY 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) 0121 382 5493 Caretech Community Services Limited Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10/2/05 Brief Description of the Service: 228 Kingsbury Road is an adapted domestic property. The home offers accommodation over three floors, and comprises of a lounge, relaxation room, kitchen/diner, ground floor wc. On the first floor are three single bedrooms, and a bathroom. On the second floor is a staff sleep in room/office. The home has a rear garden, and a laundry is located in out buildings. Service users require full mobility to live in this home. The service provides care and support to three adults who have a learning disability, and some behaviour that challenges. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector undertook this visit over the afternoon and evening of one day. Information was collected by talking with the people who live in the home, observing the care and support they were offered, talking with staff, looking around the home and reading records about care and the running of the home. Since the last inspection 228 Kingsbury Road has been taken over by a new care provider. What the service does well: What has improved since the last inspection? The inspection did not identify that all the required improvements had been made since the last inspection. A large number of requirments made at previous visits to the home remain outstanding. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 6 The staff have arranged for more inhouse activities to be provided for people. This includes opportunities to help with cooking and baking, housework, or in house leisure. The plans for supporting people who have epilepsy had been developed and were much improved from the previous visit. 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. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home has a stable service user group. There are no residential vacancies, and no new service users had been admitted. EVIDENCE: Standards not assessed at this inspection. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Service users individual’s needs and choices were not well planned or met. Risks service users were taking were not well assessed. Risk assessments did not promote safe risk taking. Records were safe and securely stored. EVIDENCE: The plans of two service users were assessed. There had been some development of the plans since the last inspection. The inspector did not find that the plans fully reflected or underpinned the service users known needs. Not all plans provided staff with clear working information about how to meet service users needs. The plans did not show evidence of consultation with the service user, or evidence that their wishes and preferences had been sought and incorporated. During the inspection opportunities for service users to decision make regarding food and drink and in house activities were offered. A discussion about the menu was undertaken, and service users confirmed they are involved in menu choices. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 10 The daily records evidenced that opportunity to undertake household tasks were available. The opportunities included assisting with cleaning, laundry and food and drink preparation. It was positive that meetings are held with service users regarding the operation of the home. It is unacceptable to again note that issues and ideas which had been generated from these meetings, had not been actionned or evidenced. The model of risk assessment remains in need of review and development. The new care provider has circulated new risk assessment documents, which if fully and accurately completed will better identify and manage risks. Risk assessments available on file were not all current, or had been subject to regular review. Examples of documents written up to two and half years previously that had not been reviewed were available. The inspector identified occasions were this has potentially limited opportunities available to the individual, as their progress and development had not been reflected in the document. As a result staff support ratios for example had not been reviewed, which had impacted upon the persons ability to access the community. Records in the home were stored securely. No breaches of confidential information were noted. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Service users had not been supported by the home to undertake a range of interesting or varied activities that would contribute to personal development or which were consistent with their peers of the same gender or culture. EVIDENCE: All three service users attend structured day opportunities for at least some part of the week. During discussion with service users it was apparent this plays an important part in their life, and the staff and other users of these services are valued members of their social network. Care and support plans are not written in such a way that identifies opportunity for development, or makes plan to enable this to occur. The range and frequency of opportunities available was again identified as a concern. Service users undertake few community-based activities outside of college and Gateway club. Opportunity to undertake household or personal shopping, to pursue hobbies or leisure are provided infrequently. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 12 In house activities had improved. The range and frequency of these continues to require improvement. The staff work with service users to ensure relationships with members of their family and friends are maintained. Service users told the inspector of visits and phone calls they had made. Service users are also supported to celebrate special family occasions and birthdays. The food available at the time of inspection was varied and interesting. Fresh fruit and salad had been provided. It was positive that a time of relaxation and chatting occurred over a drink and snack as service users returned from the daytime activities. Service users reported favourite foods were included on the menu. It is required that the amount of fruit and vegetables offered and served be reviewed to ensure this is adequate. The home provides service users with long life milk, and it is recommended that fresh milk also be provided. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Service users are supported to undertake personal care to a good standard. Healthcare monitoring is undertaken when required. Behaviour and anxiety management planning is not robust. Medication management is good. EVIDENCE: It was evident that service users had been supported with personal hygiene. Discussions with service users and evidence in the daily records showed this was undertaken frequently. Plans regarding how personal care needs are to be met were assessed for two service users. Both plans contained very vague information such as, ”Needs help with dressing” that did not provide staff with clear working guidance on how to support the service user. One plan sampled contained some very detailed information, and was specific to the individual. The plan also contained no plan to assist in the development or furtherance of skills in this area. Service users were sensitively supported to wipe their hands and mouth after eating. At some point during the inspection all three-service users experienced their trousers slipping down, resulting in their dignity being compromised. This has Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 14 been raised before and service users continue to require assistance in this area. The care planning documents are again under review. At the time of inspection these did not fully address or underpin service users needs, and did not all show sign of recent review or development. Some plans were not fully completed. One example regarding eating and drinking had been left blank regards who to contact and what to do if a problem arose in this area. It was evident reviews of health care needs, and routine health monitoring is undertaken. The home must evidence if follow up is undertaken when a service user declines or misses an appointment. Plans to underpin Epilepsy care needs had been developed as previously required. The service users display some difficult to manage behaviours. In the two files assessed PAMOVA risks assessments were available but blank. One plans regarding anxiety and aggression was assessed. This document had last been subject to review in November 2004. Several of the plans and risk assessments available detailed behaviours that are no longer displayed, or which have significantly dropped in frequency. One behaviour intervention plan had been written in January 2003. This showed no sign of development or review. Plans and risk assessments must be kept under review to ensure they accurately reflect service users needs, and that opportunities for development are provided. Medication management was good. The records of receipt and administration were robust. The home undertakes a weekly audit, to ensure medicines are being given as prescribed. One bottle of liquid medicine has leaked over the container of some other products. Staff must ensure they clean such spills up. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 15 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): X None of these standards were assessed. EVIDENCE: The CSCI received a complaint about this home in April 2005. The complaint was referred to the provider for investigation. The complaint was partly upheld. These standards were not assessed at this inspection. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30 The home accomodates service users in a domestic and homely environment. The cleanliness and presentation of the home is not adequate to ensure service users comfort and welfare. EVIDENCE: The home is an adapted residential property, and it is positive that it is not distinguishable as a care home. The service users accommodated appeared to feel comfortable in the home, and two of the people the inspector spoke said they were happy with the facilities provided. The inspector assessed that the premises meet service users needs. It is positive that new locks have been provided for service users bedrooms doors. These enable service users privacy, while not hindering free movement. Attention to cleanliness was required in some areas. Examples such as the lounge carpet that needed to be vacuumed, spills that had not been cleaned and the interior of both the oven and microwave were brought to the homes attention. An offensive odour was apparent in the first floor bathroom. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 17 Minor repairs such as the replacement of the split toilet seat in the first floor bathroom, repair of broken plaster in the back bedroom and securing the glass on the inside of the oven door were noted. The pathway at the front of the home urgently required resurfacing. The kitchen urgently requires upgrading. Stains from significant water ingress from the first floor remain on the kitchen ceiling. This room requires attention throughout including décor, furnishing and flooring. The standard of décor, flooring and furniture within the home required attention. This is not reflective of the service users age, and cultural background. Some items appear worn or tired, and in need of replacement. The previous provider had installed a washing machine with sluice facility. The inspector could not establish this had been fitted to comply with the water safety regulations, as soiled waste water was being released into the normal household waste drain. The garden at the rear of the home was clean and tidy. It remains a recommendation that this area be developed to provide a more pleasant space in which service users can relax, or undertake activities. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 18 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): 33 Adequate numbers of staff were not provided to enable service users to undertake community based activities on a regular basis. EVIDENCE: The rota identified that two staff are provided at most times. The inspector did not assess this to be adequate to meet service users assessed needs or to provide the level of support as identified in risk assessments. It has been required that the number of staff on duty be reviewed and increased, to enable service suers to undertake activities of their choice in the community. During the inspection a positive relationship between staff and service users was observed. Staff demonstrated a good understanding of the service users needs. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,41,42 The homes management is not sufficient to ensure outcomes for service users are positive, and that they benefit from a well run home. EVIDENCE: The home has an acting manager who has applied to the CSCI for registration. The inspector finds the acting manager very committed to the home and needs of the service users accommodated. It was how ever of concern that more notable progress towards meeting previously made requirements had not been made. The service users financial records were in good order, and receipts were available to underpin purchases. It was of concern that so much personal money is being spent on transport. In one instance a service user was regularly spending over ten pounds a week in excess of their mobility income for travel to college. This had resulted in personal monies being spent on transport, and seriously reduced the amount of money available to purchase clothes, toiletries or to undertake leisure. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 20 The balance of one service users money significantly exceeded the risk assessed safe amount, over a pro-longed period. It is required this be reviewed. It is recommended that the structure and presentation of records be reviewed to ensure that current active information is easily available. It is also recommended that pro-formas that help staff identify when testing or review is due also be developed. An example of this is the fire alarm and emergency lighting. The home had evidence that the fire alarm and emergency lights had been serviced. Weekly tests had been undertaken. Monthly tests of emergency lights were overdue. The staff had tested and recorded delivery temperature of hot water. This needs to be extended to include new wash hand basins. One sink was repeatedly low in temp-what done? Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 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 1 2 2 1 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 2 2 3 X 1 LIFESTYLES Standard No Score 11 2 12 2 13 1 14 1 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X X 1 X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Kingsbury Road, 228 Score 2 2 3 X Standard No 37 38 39 40 41 42 43 Score 2 X X X 2 1 X DS0000065003.V252384.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA6 YA6 YA8 Regulation 12 and 15 Requirement Timescale for action 09/01/06 09/01/06 31/10/05 4 YA9 5 6 7 YA9 YA9 YA11 8 YA14 9 YA17 Plans that fully underpin the needs of service users must be developed. 12(2)(3) Service users must be consulted regarding the development and review of their plan. 12(2)(3) Matters identified in service 16(2)(m-n) users meetings must be explored, and evidence of action taken made available. 13(4)(a-c) Risk assessments must be reviewed at least six monthlysooner if service users needs change. 13(4)(a-c) An effective tool for assessing risk must be developed and implemented. 13(4)(a-c) Risk assessments must be developed to enable service users development. 12(1)(b) Opportunities for service users growth and personal development must be included in their individual plan. 16(2)(m-n) Access to community activities 12(1)(b) must be increased. Service users must have access to a range of community activities of their choice. 16(2)(i) The amount of fruit and DS0000065003.V252384.R01.S.doc 31/10/05 28/11/05 28/11/05 09/01/06 31/10/05 31/10/05 Page 23 Kingsbury Road, 228 Version 5.0 10 YA18 12(1)(a-b), 15 12(1)(a) 12(1)(a) 13(1)(b) 12(1)(a) 13(1)(b) 13(4)(a-c) 13(6) 15(2)(b) 11 12 13 14 15 YA18 YA19 YA19 YA19 YA19 vegetables offered must be reviewed, and increased. Care documents must provide staff with specific information on how to meet service users personal care needs. Service users must be supported to protect their dignity. Care documents must provide clear guidance on how all health care needs are to be met. Evidence of follow up if appointments are missed or declined must be provided Difficult to manage behaviour must be risk assessed and planned. The service users plan must be kept under review-six monthly or sooner if needs change. 09/01/05 31/10/05 31/10/05 31/10/05 09/01/06 09/01/06 16 17 YA20 YA24 18 19 YA24 YA24 20 21 22 23 24 YA24 YA30 YA30 YA30 YA33 The medication store must be kept clean and in good order. 23(2)(b) Décor and furniture throughout the home must be updated and replaced where broken and worn. 23(2)(b) The front path to the home 13(4)(b-c) must be repaired or replaced. 23(2)(b) Repairs including securing the oven door glass, repairing plaster in the back bedroom and replacing the split toilet seat must be undertaken. 23(2)(b) The kitchen must be 23(5) redecorated, to include the replacement of the floor. 23(2)(d)(p) Odour management must be improved in the first floor bathroom. 16(2)(j) All areas of the home must be 23(2)(d) maintained to a satisfactory level of cleanliness. 23(5) Plumbing of the sluice washing machine must be compliant with the Water Regulations Act. 18(1)(a) The number of staff provided DS0000065003.V252384.R01.S.doc 13(2) 31/10/05 12/12/05 12/12/05 31/10/05 12/12/05 31/10/05 31/10/05 31/10/05 14/11/05 Page 24 Kingsbury Road, 228 Version 5.0 25 26 27 YA41 YA42 YA42 13 23(4)(c )(iv) 13(4) 23(2)(j) must be adequate to enable service users to undertake activities of their choice, consistent with their peers. Arrangements for service users transport must be reviewed to ensure they are affordable. Emergency lighting must be tested monthly, and a record of such made. Evidence of action taken when water delivery is not at 43°c must be available. 30/11/05 07/10/05 07/10/05 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 YA17 YA27 YA41 Good Practice Recommendations It is recommended that fresh milk be provided in the home. It is recommended the garden be further developed to provide a place to relax, and for leisure. It is recommended that the arrangement of service users files be reviewed and that information be stored and presented in an easy to access and understand manner. Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Kingsbury Road, 228 DS0000065003.V252384.R01.S.doc Version 5.0 Page 26 - 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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