Inspection on 04/05/06 for Linwood

This inspection was carried out on 4th May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Linwood 06/07/09

Linwood 10/02/09

Linwood 29/08/08

Linwood 31/08/07

Linwood 19/04/05

Linwood 01/12/04

Linwood 19/07/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Linwood Linwood 9 Mercer Close Thames Ditton Surrey KT7 0BS Lead Inspector Damian Griffiths Key Unannounced Inspection 4th May 2006 10:00 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 Linwood DS0000059210.V294543.R01.S.doc Version 5.1 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. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Linwood Address Linwood 9 Mercer Close Thames Ditton Surrey KT7 0BS 0207 759 9100 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) sharon.blackwell@anchor.org Anchor Trust To Be Confirmed Care Home 66 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (9) Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the service users to be accommodated in the home up to TWENTY SEVEN may fall within the category Dementia DE(E) and up to NINE may fall within the category Physical disability PD(E). Temporary respite care may be provided for one named service user under the age of 65 years. 20 September 2005 2. Date of last inspection Brief Description of the Service: Linwood is a purpose built home, opened in April 2004 and provides accommodation and care for up to sixty-six people who are elderly, some of whom may have dementia and/or physical disabilities. The home is owned and managed by Anchor Homes who are the registered providers. The home is located in a residential area within walking distance of Thames Ditton with its shops and other amenities. There is a GP surgery close by at which all residents are registered. There is car parking to the front of the building and more parking and an enclosed, well maintained garden to the rear. The accommodation is divided into six named units over three floors. The home has wheelchair access on all floors, however wheelchair users are restricted to two per unit for health and safety reasons. There are eighteen single bedrooms on the ground floor; all have a fully functioning en-suite bathroom. There are forty-eight single bedrooms over the first and second floors, these are all fitted with en-suite bathrooms, however a one off charge is made for these to be made functional. Communal facilities are arranged on each floor, these include small kitchens, dining rooms, lounges, toilets and assisted bathing facilities. There is also a hairdressing suite and a large reception area on the ground floor. All floors can be reached by staircase or passenger lift. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection undertaken by the Commission for Social Care Inspection (CSCI) in the year April 2006 to 2007 using the new ‘Inspecting for Better Lives’ (IBL) process. The IBL process involves a pre-inspection assessment of service information from a variety of sources initially helping to prioritise the order of inspections and identify areas that require more attention during the inspection process. A new ‘Inspection record’ is compiled from details of the previous inspection and other details supplied by the home that includes a pre-inspection questionnaire and notifications of significant events known as regulation 37 notifications. Comments and complaints received and previous inspection reports are all considered for inclusion to the Inspection record prior to the inspection visit. For more details of ‘IBL’ please visit the Commission for Social Care Website details can be found on the last page this Inspection report. Lead Regulation Inspector Damian Griffiths was assisted throughout the inspection by the registered manager Mrs Lorraine Hills-Avery representing the establishment. The inspector was with staff and residents at Linwood for a period of 7½ hrs. This time was spent sampling resident’s care need assessments, care plans, contracts and talking to residents and staff. Staff files were inspected for evidence of good practice in the following areas: recruitment, allocation of staff skills, daily rotas and training. A tour of the premises and grounds was completed and friends and relatives were also able to comment and the Inspector stayed for lunch. The inspector would like to extend thanks to the residents staff and management at Linwood for their assistance and hospitality What the service does well: Residents were well cared for and able to choose the things they enjoyed doing within the home. Staff respected their privacy and always offered a good welcome to friends and family visiting and ‘going the extra mile’ by providing residents with additional support when needed. This included a birthday party observed on the day and it was noted that a special birthday cake had been baked and iced for a grandchild to enjoy with their grandparent. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 6 The day of the inspection was the day of the local elections and residents wishing to vote were assisted to perform this right. Care plans followed a standard pattern to Anchor homes but contained a lot of information when completed properly and residents choices were respected and recorded by signed risk assessments for self medication and whether a preference for a male or female staff member to assist with personal care. The home is currently reviewing how it provides care for residents with dementia and was proposing to have a separate dementia unit. No decisions have been made yet due to the need to consult with residents, relatives and health and social care practitioners. Complaints had been managed with courtesy and openness. Staffing levels were good and no agency staff were currently being employed. The home environment is modern and clean but homely, each unit having its own name and there are places to be alone to watch the world go by. What has improved since the last inspection? What they could do better: Residents with dementia care needs would benefit from a reassessment of their care needs with particular attention to daily structured activities. It was not evident whether residents risk assessments had improved apart from the standard Anchor assessment models mentioned. Falls were being appropriately recorded and database had been created however it was not clear how this information was benefiting the residents at risk although they were being referred to a falls clinic. Activities did not reflect the needs of the residents consulted. Staff training needs in; Challenging behaviour management, Adult protection and Dementia Care still needs to be far more extensive and overall level 2 NVQ must be achieved by 50 of all staff. The recording of outcomes for each complaint investigated and managed needed to be made clearer. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 7 Recruitment standards were not up to standard and must be improved with all staff files in need of review and staff supervision be updated and implemented. 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. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 8 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 Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents had received good assessments of need and care plans reflected the tasks required however some residents required more detailed accounts of how the home would provide care. EVIDENCE: Residents had received a full assessment from the home and the Social care Teams representing the local authority. Respite residents however had received an assessment but did not have care plans to direct and ensure staff to the areas of need required to support the resident. Care plans for dementia need residents did not specify how their days were to be filled or how staff should respond. Please see the recommendations and requirements section of this report. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. Care plans were generally good but some residents required more detailed account of how their care needs were to be met. Residents received the correct level of care and attention, regular medication was administered safely , however, some minor improvements were required. Residents consulted generally felt that their privacy was respected. EVIDENCE: A sample of six care plans was inspected in depth and consisted of residents with dementia needs, new residents and short stay or respite residents. The care plans sampled showed a good overall level of detail for residents without dementia care needs or those staying for short breaks. Care plans included clearly defined tasks, contracts, and risks assessments and had received a review. Health care records were good; residents’ falls were being monitored and were being referred to a falls clinic for to establish methods of prevention. Medicines Administration Records (MAR) were sampled for six residents and were all in order showing the daily dosage was regular and signed by the Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 11 appropriate staff member trained to do so. Residents should have their photos attached to the medicines records to reduce the risk of mistake and encourage familiarity. Photos were missing and others required updating. The majority of residents consulted stated that their privacy was respected and it was observed that staff would always knock on the door of a resident’s room before entering. Staff addressed the residents in a manner of their choosing and resident relatives confirmed that they were always allowed privacy when visiting. Please see the recommendations and requirements section of this report. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. Activities provided at the home needed to be regularly reviewed. Residents were able to maintain links with friends and family and access the local community. Individual choices were recorded and residents benefited from a wholesome and varied menu. EVIDENCE: Several residents were consulted and they felt that activities at the home were not suitable. Staff were observed helping residents in a variety of activities ranging from group singing to individual birthday parties. It was not evident whether residents care plans had been used to assess the suitability of the activity or whether success or failure was being recorded in the daily diary record compiled by staff. One group of residents, with varying levels of sight impairment were in a lounge trying to watch a television that was not properly tuned to the station causing a grainy picture. The resident’s comments were sought and it was apparent that some residents with dementia care needs were amongst the group. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 13 The home had employed two activities organisers to help address these issues and the home was committed to developing a better response to the needs of residents with dementia. Staff at the home were observed to be welcoming and helpful to families and visitors to the home. Celebrations of birthdays was well supported, the chef had made a lovely birthday cake for a grandchild to enjoy with their grandparents at the home. Residents confirmed that they were able to access the ballot office in their local area or use the postal vote system available. The chef offered a good variety of wholesome food to the residents who were consulted at the end of every day for their choice of meal the next day. Residents’ comments were positive about the choice of food and the chef winning the ‘Young at Heart’ award from Elbridge Council confirmed the quality of the food served, an excellent achievement. Please see the recommendations and requirements section of this report. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A number of complaints had been investigated satisfactorily however the outcome of some was unclear. Resident’s rights were respected and the Protection of Vulnerable Adult procedure was in place. EVIDENCE: The home had received eight complaints over the past 12 months all had been addressed and recorded. A clear record of the complaints was held in a journal showing the actions taken. The outcome of a few was unclear although it was apparent that they had received attention. A number of residents have their affairs managed by their relatives and the home has a record of representatives with ‘Power of Attorney’ and supports residents with their own financial arrangements. There has been one incidence requiring the Surrey Multi-disciplinary procedure for ‘Safeguarding Adults’ to be activated and therefore the home has demonstrated it’s understanding and ability to respond well. The staff team are receiving training on ‘Safeguarding Adults’ as two out of the four staff files inspected evidenced this. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home environment was clean tidy and welcoming however the residents had not managed to access the garden. EVIDENCE: A tour of the home and grounds was conducted and revealed a well kept and modern home that was completed two years ago. There were no requirements made relating to the structure of the building however the grounds were in need of seasonal attention: lawns mowed, weeds removed and planting to commence. The resident’s rooms were clean, tidy and showed individual tastes had been respected and encouraged with photos and favourite furniture in evidence. Equipment was in good order and toilets and bathrooms clean and well provisioned however televisions need to reflect the needs of the residents and be suitably tuned, offering clear and visible pictures and contain a loop system. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 16 The kitchen was clean tidy and efficiently run but the kitchen pantry would benefit from a window blind to ensure reduction of heat on a sunny day. Please see the recommendations and requirements section of this report. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff had inadequate skills to meet all the needs of residents with dementia care needs however good levels of training were being achieved. Staff recruitment was adequate but in need of improvement. EVIDENCE: Staff files were sampled to compare skill levels achieved and compared with the rota that had been prepared for the staff working the night shift. Skills evidenced included: Moving and handling (described as back care in Anchor homes), Protection of Vulnerable Adults, First Aid, Safe Administration of Medicines, Fire and Health and Safety. Residents therefore were provided with staff that were adequate in skills and numbers to meet their needs. Staff with level 2 NVQ were estimated to be only 10 of the workforce. Staff receive training in the prevention, protection and recognition of adult abuse but no mater what reasonable measures are taken it does not guarantee that abuse or allegations of abuse will not occur. A member of staff had been suspended from duty at the home until an investigation had been completed. Recruitment documents were not all in place and most files sampled were for long-term staff therefore two additional staff files were sampled. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 18 Some files contained only one valid reference, gaps in employment history and one file showed an invalid immigration status document. Long-term staff had not received a police check for over three years. Two out of the four staff files sampled showed that dementia care training had been received. Managing challenging behaviours training however had not been received by any of the staff sampled. Please see the recommendations and requirements section of this report. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager had applied herself well in the few months she has been in post and was supported well by staff. There was a need to conduct a Quality Assurance exercise as some residents felt their needs were not being met. There had been problems with the resident’s personal finances but the health and safety of the residents was being met. EVIDENCE: The manager has made a good start to the tasks identified in the previous inspection. Difficult management issues relating to staff have been dealt with and staff had been treated in a respectful manner. Residents consulted were still reflecting on the speed of change from the previous management and would benefit from more contact from the manager. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 20 A quality assurance exercise was due at the home to establish how change has affected the residents since the new building was opened. Service users were not sure who the manager was and some would like to be more involved in decision making. This would also benefit the current proposal for the implementation of a dementia unit at the home as some residents may wish to know how this would work. Comments had been received by CSCI regarding the management of resident’s personal finances. Inconsistent charging systems had meant that some residents charges for personal items such as hairdressing, newspapers etc had not been regularly billed. Residents were being charged large amounts of money as the bills mounted. The manager has taken this up with those responsible and enabled a lot of the bills to be written off, this was an excellent response from the Anchor organisation and the best result for residents at Linwood. The premises were inspected for any health and safety concerns. The home has a good method of accident recording known as AIM ‘Accident and Incident Monitoring’ incidences of falls were recorded and entered onto a database. Fire drills and equipment testing was up to date, the home is advised by the fire officer and operates the ‘Stay put’ procedure in the case of a fire. ‘Praise for Gold, Food and Hygiene’ award had been made to the home from Elmbridge Council. Please see the recommendations and requirements section of this report. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 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 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 4 X X 4 Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4OP7 Regulation 14(1) 15(1) Requirement The registered manager must ensure that all residents receive a care plan and that they show how the specialist needs of residents with dementia are to be met. The registered manager must ensure that an up to date and recognisable photo of the resident accompanies all MAR charts. The registered manager must ensure that care plans contain and record and ‘assessment of activity’ and that it is relevant and suitable for each resident. The registered manager must ensure that the pantry window is furnished with a window blind and the garden is maintained appropriately to reflect the seasonal need. The registered manager must ensure that TV equipment is appropriately fitted and serviced and that it reflects the assessed needs of the residents. The registered manager must ensure that all staff receive the DS0000059210.V294543.R01.S.doc Timescale for action 04/06/06 2. OP9 12(1) (a) 13(2) 04/06/06 3. OP12 14(1)(2) (a) 15(2)(a) 23 (2)(m) 04/06/06 4. OP19 04/06/06 5. OP22 23(2)(c) 04/06/06 6. OP28OP30 18(1)(a) (c) 04/06/06 Linwood Version 5.1 Page 23 7. OP29 19(1)(a) (c) Schedule 2. 8. OP33 24(1)(a) (b)(2)(3) required training to safeguard adults, manage challenging behaviour and ensure that 50 of staff reach NVQ 2 levels. The registered manager must ensure that all staff have received the appropriate recruitment vetting and can produce documentation to support their applications. Documents to include up-to-date passport and immigration status, two references, proof of identity and police checks. The registered manager must provide residents, friends, relatives, social care and health practitioners with an opportunity to comment on the quality of the home by ensuring that a Quality Assurance monitoring exercise is conducted. 04/06/06 04/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP29 OP1 Good Practice Recommendations It was recommended that all long-term staff files be reviewed to ensure that Police checks were up-to-date. It is recommended that the homes produce its service users guide in formats that are accessible to those service users who are unable to understand the written format. Linwood DS0000059210.V294543.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Linwood DS0000059210.V294543.R01.S.doc Version 5.1 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. 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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