Inspection on 21/06/06 for Kneller Road, 131

This inspection was carried out on 21st June 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 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kneller Road, 131 07/02/06

Kneller Road, 131 14/09/04

Kneller Road, 131 07/05/04

Kneller Road, 131 27/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 131, Kneller Road Whitton Middlesex TW2 7DY Lead Inspector Simon Smith Unannounced Inspection 21st June 2006 1:00 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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 131, Kneller Road DS0000017375.V305056.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 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. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 131, Kneller Road Address Whitton Middlesex TW2 7DY 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) 020 8893 4636 020 8893 4636 None United Response Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: The property is owned and maintained by Thames Valley Housing Association. The service is managed by United Response, a not-for-profit provider of community services for people with learning disabilities. The home’s fees are currently £1333 per resident each week. Opened in 1996, the home is a single-storey property situated in a pleasant residential area. Whitton high street is close by and provides a range of shops, pubs and other community facilities. The home is set back from the road and approached via a driveway. Parking is available to the front of the property. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector used evidence from a range of sources when making judgements about the home. These included two visits to the home and discussion with residents, the manager and staff. Surveys were given to residents, relatives and professionals who visit the home. A sample of records was examined, including staff and residents’ files. The inspector was made welcome during the visits and wishes to thank residents, staff and all those who gave their views about the home. The home met 25 of 32 National Minimum Standards assessed at this visit. Five Standards were almost met and two Standards were not met. Two Requirements made at the last inspection had not been met by the home and are reinstated in this report. Relatives said that they were satisfied with the standard of care provided and confirmed that staff understand residents’ needs. Some staff said that they had not been well supported by the home’s management team, reporting that supervision sessions were not held often enough and that team meetings achieved little. Staff also said that their ideas about improvements were not taken on board or actioned by the home’s management team. A new manager and deputy manager have recently been appointed and it is hoped that this will lead to improvements in a number of areas, including the supervision and support provided to staff and the reliance on agency staff. The new management team should also aim to improve recording and administration to ensure that staff work with information that is accurate and up to date. What the service does well: What has improved since the last inspection? 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 6 A new manager with relevant experience has been appointed. Residents’ reviews have taken place. 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. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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): 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to the home. Residents’ individual needs are assessed. There is a commitment to improving communication opportunities for residents. EVIDENCE: Three residents’ files were examined. Each contained a needs assessment, completed at the time of admission, which identified individual strengths, needs and preferences. The manager advised that developing opportunities for effective communication is a priority for the home and that improvements in this area will greatly benefit residents. The manager stated that the UR First team of United Response plans to provide training for the staff team around communication in the near future. In addition the plans to meet the speech and language therapist employed by the local community team to discuss training for staff in this area. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 9 Makaton training has been planned as some residents have skills in this method of communication. The manager stated that one member of staff will attend advanced Makaton training to enable him to communicate effectively with his key client, who has good skills in this area. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. The home records residents’ needs and strengths and works with residents to identify goals that are important to them. Staff understand residents’ individual needs. Residents receive good support to make informed choices about their lives. EVIDENCE: An individual plan of care is in place for each resident. Care plans reflect the individual skills, strengths, needs and goals of residents and record preferences in terms of daily routines and activities. The residents’ files examined contained individual medical profiles but some sections of the profile were blank or undated. The manager reported that all residents but one had had recent reviews and that a review for the final resident was planned for the near future. This was 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 11 confirmed by examination of residents’ files. The manager advised that residents’ care plans will be further reviewed to ensure that individual objectives are specific, measurable and time limited. The home plans to introduce individual spending plans for residents. These plans will identify sources of income and likely expenditure to improve effective budgeting and financial planning. Staff spoken to during the inspection demonstrated a good knowledge of residents’ individual needs and a commitment to supporting residents in making informed choices and decisions about their lives. Discussion with staff also demonstrated that there is a commitment to promoting the rights of residents to take manageable risks in their lives. Risk assessments have been developed for specific activities undertaken by residents. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. Residents participate in activities appropriate to their needs and preferences. Residents are involved in their local community. Residents are supported to maintain relationships with their families and friends. Residents are consulted about the home’s menu. EVIDENCE: Residents take part in a range of activities according to their preferences. Some residents make use of formal day services, such as local resource centres, whilst others make more use of community facilities. The manager reported that residents’ day services will be reviewed in the near future to ensure that they meet residents’ needs. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 13 All residents have at least one annual holiday. Two residents travelled to Spain with three staff in July, whilst two residents and three staff had stayed at CentreParcs two weeks earlier. Staff advised that two more residents plan to visit CentreParcs in September. Most residents have regular visits from or contact with family members. Staff reported that residents who do not receive regular visits are supported to maintain contact with their relatives by letter or telephone. Interaction between staff and residents was positive during the inspection. Staff used appropriate forms of address and treated residents with respect. The inspection provided evidence that United Response has provided advice for residents on the issue of direct payments and has informed residents about the forthcoming changes to the management of the property. Each resident has individual charter on file that sets out tenants’ rights and responsibilities. Residents have unrestricted access to all communal areas and are able to choose how they spend their time at the home. Residents are registered to vote. The advertised menu indicated that the home provides a varied and wellbalanced diet. Staff said that residents are encouraged to contribute to menu planning and that alternatives to the planned menu are available where required. Snacks and drinks are available at any time. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the home. There is a commitment to involving appropriate healthcare professionals in residents’ care where needed. Residents are supported to access community and specialist healthcare resources where necessary. Changes in resident’s healthcare needs are identified by staff and receive an appropriate response. Residents’ medication is appropriately stored and accurately recorded. EVIDENCE: As highlighted in the ‘Choice of Home’ section of this report, the manager identified communication as an area for attention and improvement. The manager is committed to seeking the input of appropriate professionals and developing consistent guidelines for staff in their work with residents. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 15 There is evidence that changes in resident’s health needs are identified by staff and that any changes receive an appropriate response. For example an increase in one resident’s falls was addressed by a referral to appropriate professional. Two residents have day hospital appointments in July 2006 and the manager stated that staff are working with these residents to ensure their understanding of the process. There is an appropriate system for the storage and administration of medication. All medication coming into or leaving the home is recorded. There are clear written procedures for the administration of medication. Sample staff signatures are held on file. Double signatures are used to record medication. Medication records included residents’ photographs. Homely remedies and PRN medication are recorded. Inspection of medication records for two residents revealed no omissions or errors. No residents self-medicate. The last medication check by the visiting pharmacist took place in November 2005. The home’s policies state that these visits should take place twice each year. It is recommended that the home arrange a medication check with the pharmacist. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to the home. Appropriate procedures are in place for the management of complaints. Training and guidance is provided for staff in the recognition, prevention and reporting of abuse, although some staff have yet to attend this training. EVIDENCE: The home has an appropriate Complaints procedure. There have been no complaints made about the home since the last inspection. The service works within the ‘Joint Policy on Suspected Abuse of Vulnerable Adults’. United Response has a Whistle-blowing procedure, which enables staff to report any concerns about they have about poor practice. Some staff said that they had yet to attend training in Abuse and the Protection of Vulnerable Adults. See Requirement 1. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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, 25, 26, 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to the home. The home is comfortable, safe and hygienic. Residents’ bedrooms reflect individual preferences. Some areas of the home would benefit from redecoration. Some residents did not have access to hot water in their bedrooms. EVIDENCE: The home is situated in a pleasant residential area and has good access to local community facilities, open spaces and public transport networks. The property is currently owned by Thames Valley Housing Association but ownership and management will be transferred Threshold Support in the near future. The manager advised that Threshold Support plans to assess the condition of the property and to address all areas that need improvement. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 18 The communal rooms of the home include a living room, separate dining room and kitchen. There is a large, well maintained garden. All areas of the home were clean and hygienic although some communal areas, especially the hall, would benefit from repainting. There are enough bathrooms to meet residents’ needs and adapted equipment is in place in bathrooms where necessary. The last inspection report recommended that the bath in one bathroom be replaced. This recommendation had yet to be implemented and is reinstated here. Residents’ bedrooms reflect individual tastes, preferences and hobbies and contain specialist equipment (such as adjustable beds) where needed. The sinks in two residents’ bedrooms did not have a sufficient supply of hot water. See Requirement 2. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to the home. There has been high use of agency staff to supplement the permanent staff team. Staff have a range of appropriate skills but have previously not received adequate management support or supervision. Effective communication amongst the staff team has not been promoted through regular team meetings. EVIDENCE: The home has historically made much use of agency staff. Whilst the service aimed to employ those who were able to offer a degree of commitment to the home, high usage of temporary staff detracted from the continuity of care provided to residents. The manager is committed to reducing the use of agency staff and advised that three applications from prospective permanent staff had recently been received. Agency staff spoken to during the inspection said that they were introduced to residents when they started work and were made aware of their individual 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 20 needs. Agency staff also confirmed that they were expected to read and understand residents’ care plans, although said that they had not received regular supervision. Three staff files were examined. All provided evidence of an appropriate recruitment procedure and pre-employment checks including Criminal Records Bureau disclosure, proof of identity and written references. Staff reported that they are encouraged to attend training relevant to their roles. Staff files provided some evidence of appraisal in the past but none in the last year. It is recommended that a system of annual staff appraisal be reintroduced. Some staff said that team meetings were infrequent and lacked focus, often failing to achieve actions identified. Inspection of team meeting records minutes demonstrated that meetings should take place more often and that improvements in recording are needed, as minutes were illegible. See Requirement 3. In addition staff felt that the support and guidance provided by the previous management team was inadequate to enable them to do their jobs well. Staff said that the quality of supervision was poor and that the support provided when they started work was not sufficient to enable them to work effectively with residents. See Requirement 4. It should be noted that team meetings and staff supervision were areas identified for improvement following the last inspection of the home in February 2006. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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, 41, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to the home. The new manager has experience relevant to the role and a commitment to improving the service. The home must formalise the way in which residents’ views are sought and recorded. Information held on residents’ and staff files should be reorganised and archived where appropriate. Instructions to be followed in the event of fire must be reviewed. EVIDENCE: A new manager had recently been appointed at the time of inspection. The manager has experience of managing another United Response service locally 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 22 and worked in local authority learning disabilities services prior to joining the organisation. In addition, a new deputy manager had been appointed, initially for a period of three months until the post is readvertised. The manager advised that she has submitted an application for registration with the CSCI. As highlighted in the previous section of this report, some staff indicated that leadership and communication from the home’s previous management team was inadequate. It is hoped that the appointment of a new management team will improve the supervision and support provided to staff and promote effective communication amongst the team. Discussion with staff confirmed that there is commitments to running the home in the best interests of residents and to ensuring residents’ wishes are met wherever possible. However the home must formalise the way in which residents’ input is recorded to demonstrate how residents are involved in the life of the home and consulted about decisions that affect them. See Requirement 5. Accidents and incidents affecting residents are recorded. Staff perform a ‘hazard inspection’ each month. Portable appliances were checked in March 2006. The fire alarm system and emergency lighting system were checked in June 2006. Information held on residents’ and staff files would benefit from reorganisation to ensure that staff work with information that is accurate and up to date. Old material should be archived and formats used for recording should be standardised. See Requirement 6. The most recent fire drill took place on 8 June 2006. This drill (and a ‘Fire Safety Report’ carried out in November 2005) identified that two residents refused to evacuate the building following the alarm. The home needs to record the actions to be taken should this occur in the event of a fire. See Requirement 7. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X 2 2 X 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 24 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 2 3 Standard YA23 YA26 YA33 Regulation 13(6) 23(j) 12(2)(5) Requirement Ensure that all staff have attended training in the Protection of Vulnerable Adults. Provide an adequate hot water supply in all residents’ bedrooms. Ensure that staff meetings are held more frequently, with legible minutes recorded. This Requirement is reinstated from the last inspection. Ensure that all staff receive individual supervision at least every two months. This Requirement is reinstated from the last inspection. Develop and implement a Quality Assurance system that effectively records residents’ views about all aspects of the service and identifies areas for potential improvement. Improve the quality of recording and administration information to ensure that staff work with information that is accurate and up to date. Record the actions to be taken DS0000017375.V305056.R01.S.doc Timescale for action 30/08/06 30/08/06 30/08/06 4 YA36 12(5) 18(c) 30/08/06 5 YA39 12(2)(3) 24 30/08/06 6 YA41 17 30/08/06 7 YA42 23(4) 30/07/06 Page 25 131, Kneller Road Version 5.2 should residents refuse to evacuate the building following a fire alarm. 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 4 5 Refer to Standard YA6 YA20 YA24 YA27 YA36 Good Practice Recommendations Ensure that residents’ medical profiles are fully completed and regularly reviewed. Arrange a medication check with the pharmacist. Repaint the communal areas of the home. Replace the bath in one bathroom. Implement a system of annual staff appraisal. 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 131, Kneller Road DS0000017375.V305056.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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