CARE HOMES FOR OLDER PEOPLE
Lisnaveane 790 Longbridge Road Dagenham Essex RM8 2AA Lead Inspector
Ms Rhona Crosse Key Unannounced Inspection 7th August 2006 08:55 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 Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lisnaveane Address 790 Longbridge Road Dagenham Essex RM8 2AA 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) 0208 592 0022 0208 491 8424 Mr Alfred Henry Gilmore Waddell Mrs Fiona Foo Siang Waddell, Miss Julia Patricia Waddell Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th May 2006 Brief Description of the Service: Lisnaveane is a residential property that has been converted and extended over time to provide a care home for 19 older people offering 24 hour care. The home is situated on the corner of a busy road with good transport links. There is parking in the street to the side of the property. There is limited space to the side of the building for parking in the homes grounds. The home comprises of single and shared bedrooms. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced therefore the home did not know the inspector was coming. The inspector arrived at 08.55 and was met by the senior staff member on duty as the manager was at the local hospital with a service user. The manager arrived later in the morning. The home was inspected in January 2006 and then again in May 2006 due to the concerns the Commission had about the operation of the home. A new manager had been employed shortly before the last inspection in May and has now been at the home for 3 months. At this inspection there was a marked difference in the operation of the home. The manager and staff have worked hard to achieve a much better standard of documentation to support the care being provided. The Statement Of Purpose and the Service Users Guide have been updated with the current information. The problems with the fire doors that were of concern have now been addressed as the proprietor has had the door magnets replaced. Repairs that needed to be carried out around the building have also been dealt with. Staff contracts that are the responsibility of the proprietor have still to be addressed as the staff have old contracts that were drawn up by the previous owners of the home. This requirement to renew contracts by the present proprietor is a restated requirement that must be dealt with within the new timescale given or formal action may be taken against the home. A service user had been admitted outside the registration category of the home. However the person has now been at the home for some time and it would be detrimental to the service user to have to move to another establishment. The home must ensure that they are able to evidence that they can continue to care for this service user. The home must only admit service users within the category they are registered for. Any further failure to comply with the registration regulations will result in formal legal action being taken against the home for the protection of service users. What the service does well:
The staff carryout weekly checks on the fire call points and always record their findings. Records show that all fire doors are operating appropriately. The emergency lighting was checked on the 28/6/06. A fire drill took place on the 29/6/06 with an evacuation of the building. Medication returned to the pharmacy was appropriately completed for the month of July 2006. Activities are improving. Entertainers were brought into the home on the 4/7/06. Service users confirmed that a trip to Southend took place on the
Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 6 14/7/06. These activities were recorded on the activities sheets that are completed on a daily basis and identify who takes part in daily activities. Service users spoken with were happy with the service the home provided stating: ‘I like it here’ ‘ I like living here the girls are nice, there’s no arguing here among staff like you get some places, they work together and all get on well’. ‘The food is good you get too much sometimes’. ‘You get a choice of food they come and ask you what you want’. ‘I can go to my room when I want they don’t bother you, you can do as you please’. What has improved since the last inspection? What they could do better:
Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 7 Medication records were inspected and it was observed that 2 errors were made. The manager must ensure that all medication is appropriately recorded at all times. The information relating to the errors is in standard 9 of the report. It was observed that a service user’s privacy and dignity was compromised. A staff member was seen by the inspector shaving the service user in the lounge. When this was pointed out to the manager she spoke with the member of staff who then took the next service user she was about to shave back to the bedroom. Two bedrooms had an odour of stale urine in them (rooms 8 and 21). The carpets are not designed for use where there is incontinence and may therefore need to be replaced with suitable carpet if the smell of stale urine cannot be removed. The domestic stated that the carpet shampooer was not working properly and not sucking up the water. This needs to be addressed to ensure that the carpets are cleaned appropriately. The area in the centre of the garden that was being landscaped at the last inspection has not had any further work carried out; the proprietor must have this work completed. 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. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 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 Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 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): 1 The outcome group for this area is adequate and has significantly more strengths than weaknesses. The home must establish that they can meet the needs of any new service user before admission. This is to ensure the ongoing welfare of any new service user. EVIDENCE: There has been no new service users admitted to the home since the last inspection. Therefore this standard cannot be tested. The home must ensure that they only admit service users within the registration category that they are registered for. The home is not registered to take people with a diagnosis of dementia. However any service user that has developed dementia whilst living at the home is able to remain there as long as the home is able to evidence they can meet their needs. The Service Users Guide and the Statement of Purpose have now been updated. The information held would enable a prospective service user and their relatives to have an understanding of the service the home provides.
Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 10 Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 11 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 &10 The quality outcome area is adequate and has significantly more strengths than weaknesses. Reviews of all care plans are being undertaken to ensure the ongoing health and welfare of service users is being met appropriately. EVIDENCE: The new manager is reviewing all care plans. 6 care plans have been re written. These hold appropriate information in relation to the current needs of the service users. A further 5 have yet to be reviewed. All old care plans and risk assessments should be removed from the service users files and archived. Health care needs were well documented with visits from the GP and other health professionals recorded. GP instructions had been followed for one service users who is experiencing high blood pressure. Another service user has recently been diagnosed with diabetes. It was observed that a service user’s privacy and dignity was compromised, by a staff member who was seen shaving the service user in the lounge. When this was pointed out to the manager she spoke with the member of staff who then took the next service user she was about to shave back to the bedroom. The manager must ensure that this does not happen again. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 12 Medication practice was inspected. It was observed that for one prescribed medication that had been completed, the medication administration chart recorded that 7 antibiotic capsules (Trimethoprim) had been carried over onto this months medication sheet. It was noted however that there were 8 signatures recording the medication administered, indicating that staff had signed the medication administration chart incorrectly. For another medication Ferrous Frumalate 140mg/5mls there was no ‘start’ date recorded for this syrup medication. The manager must ensure that all medication is appropriately recorded at all times. In discussion with one relative it was stated that the care of their relative was good particularly her health care and things were dealt with and records he had seen had improved since the new manager had taken over. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 13 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 & 15 The quality outcome area is adequate and has significantly more strengths than weaknesses. In general the needs of the majority of service users are met and as many choices are given as possible this benefits the service users. These judgements have been made using available evidence and a visit to the service. EVIDENCE: Activities have been improved and a record of who takes part in activities is recorded. Service users confirmed that they had been on a trip to Southend with the proprietor on the 14/7/06 and that they had enjoyed this. They also spoke of the entertainers that came to the home on the 4/7/06 to sing to them. One service uses stated ‘I like to sing and dance, I get up and dance when they come’. The home is looking at employing an activities co-ordinator this will increase the opportunities and activities for service users. The manager stated that she is finding it difficult to get anyone from any of the local Churches to visit the home but she is still trying. One male service user said ‘I wish I could go out but nobody asks me’. The home must ensure that all service users have the opportunity to go out if they choose and should record any refusal if an offer is made. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 14 The home places no restrictions on visitors and visitors are able to come and go at any time. One service user stated: ‘my sister visits me regularly but not always at the same time, we go to my room and have a talk in private’. Another stated ‘visitors can come at any time, we have lots on Sunday, you should have come on Sunday and you would have seen lots of relatives then’. Service users can get up and go to bed when they choose. One service user likes to stay up late; another always rises later in the morning on a regular basis. Since the last inspection the menus have been reviewed. The menu for the day of the unannounced inspection was either beef casserole or gammon with peas pudding, carrots, brussel sprouts and boiled potatoes. The desert was Semolina pudding. Nine service users chose the beef casserole and two chose the gammon. The meal was well presented. The chef asked the inspector to taste the food. The beef casserole was very good, the meat was very tender, and the vegetables were nicely cooked. Complements were given to the chef. Service uses stated: ‘I like the food, it is always good’. Another comment was: ‘I get too much sometimes I like the food it is always nice’. ‘You always get a choice of food I have no complaints’. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 15 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 & 18 The quality outcome area is adequate and has significantly more strengths than weaknesses. No complaints are recorded as being received. Therefore it would appear that all service users and relatives remain happy with the service the home is providing. These judgements have been made using available evidence and a visit to the service. EVIDENCE: There are policies and procedures for dealing with any complaints. Staff are aware of their responsibility if any complaint is raised with them. The complaints procedure identifies the Commissions address and telephone number. The complaints book was inspected and there have been no complaints recorded since January 2006. The complaint at that time came for a service user and was dealt with appropriately, with a comment that stated the service user was happy with the outcome of the complaint. The Commission however received a complaint, and this was passed back to the proprietor to investigate. A written response was requested but has not been received by the Commission. This is poor practice, and is a restated requirement from the last inspection. The proprietor must provide a response to the Commission within the new timescale set. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 16 Staff have received training in the protection of vulnerable adults and were able to tell the inspector the process they should take if they witnessed any suspected abuse. Service uses stated ‘ We have no complaints we are all happy here’. ‘I have nothing to complain about they look after me here’. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 23, 24, 25 & 26 The quality outcome area is adequate and has significantly more strengths than weaknesses. The shared bedrooms should be turned into single occupancy to improve the quality of life for service users. Odour control is poor in two bedrooms. This compromises the dignity of service users. The carpets must be appropriately cleaned. These judgements have been made using available evidence and a visit to the service. EVIDENCE: The repairs identified at the last inspection in May 2006 have been dealt with. Although the home was generally clean and tidy, 2 bedrooms smelt of stale urine (rooms 8 and 21). The ancilliary worker stated that the carpet cleaning machine was not working appropriately, and it would not suck up the water and cleaning fluid. This needs to be repaired. The carpets are not designed to be used where there is incontinence therefore it is difficult to remove the odour of urine. If the odour of urine cannot be removed by cleaning then the carpets
Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 18 will need to be replaced with carpet suitable for areas where incontinence is a problem. The home has 4 double bedrooms (one shared room is being used as a single bedroom but a second bed is still in the bedroom). Most local authorities will no longer place service users in shared bedrooms. The proprietor should look at reducing the number of shared bedrooms and updating these vacant rooms by fitting en-suites in them. This would improve the facilities within the home. Service uses bedrooms were very individual with small pieces of furniture and lots of other personal possession evidencing that the home encourages service users to personalise their bedrooms. Bedroom 10 was not inspected as visitors were in the bedroom. This room will be inspected at the next inspection to the home. Since the last inspection locks have been fitted to the bedroom doors that are operable in an emergency from the outside. This allows service users to choose whether they want to lock their doors but feel safe in the knowledge that if an emergency arose staff could gain access. One service user requires a hoist for transfer. The bed has been changed to allow the hoist to be used appropriately. The service user has a specialist mattress to relieve pressure. Bathrooms and W.C.’s were clean and tidy. With aids and adaptations for frail service users. Clinical waste was appropriately stored awaiting collection. The laundry room was tidy with attention being paid to infection control. The garden to the rear of the property was being developed with a new flowerbed put into the centre of the garden. Work to this has stopped, and the garden is not a nice place to sit and relax at the moment. The work to create the flowerbed and finish landscaping the garden must be completed. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 19 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 & 30 The quality outcome area is adequate and has significantly more strengths than weaknesses. Staff training is still required for some staff. The manager must identify the training required to ensure that the staff are appropriately trained to meet the needs of the service users. These judgements have been made using available evidence and a visit to the service. EVIDENCE: There has been recent training for all staff in moving and handling, basic first aid and food and hygiene. Medication training has taken place and staff have ‘work books’ that they have to complete, once this is achieved they will be issued with certificates of competence. Further training is required for staff that have not received any training in dealing with dementia. One senior staff member has undertaken 3 training sessions in caring for people with dementia. Contracts for some staff were blank or they had contracts that related to past providers who owned the home. This is a restated requirement that has not been addressed by the proprietors. The proprietors must issue new contracts of employment and a copy of a signed contract must be held on file for all staff currently employed. The manager must ensure that all the recruitment and employment documentation held is appropriate for all staff. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 20 Since the last inspection the manager has created training and development plans for the majority of the staff and she is working towards completing these for all staff. The remaining staff must have formal supervision as soon as possible. Any training identified as being required as part of the supervision sessions should be listed and provided to ensure that the staff have the appropriate skills to care for the service users accommodated. Currently 31 of the staff hold or are undertaking NVQ level 2 training. The home must ensure that at least 50 of the staff team hold an NVQ 2 qualification. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 21 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 & 38 The quality outcome area is adequate and has significantly more strengths than weaknesses. The manager must undertake the Registered Manager Award training. She will then be appropriately qualified to manage the home. These judgements have been made using available evidence and a visit to the service. EVIDENCE: Since the last inspection the manager has been registered with the Commission. However she must take the Registered Managers Award training. The manager must apply to the local college to enrol on the course for intake in September this year. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 22 Since the new manager has been employed there have been 3 staff meetings the last one was for senior staff and this took place July. The home is said to hold no personal allowances for service users. Any expenditure is said to be paid for by the home and then relatives are invoiced for the amount spent. The home must ensure that if records are requested that all records are available. Six staff have received formal written supervision and have also had an appraisal of their work practice. The remaining staff must have formal supervision as soon as possible. All staff have to have 6 supervision sessions within any one ‘rolling’ year. All health and safety certificates and documentation required by legislations were in order. However the manager was requested to seek advice from the Environmental Health Officer about the water lying in pipes in vacant rooms. This has not been acted upon. This will therefore be a restated requirement. Lisnaveane DS0000027906.V307442.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 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 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X x 3 X 3 Lisnaveane DS0000027906.V307442.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 Standard OP9 OP10 Regulation 13(2) 12(4)(a) Requirement All medication must be recorded appropriately at all times. Service users privacy and dignity should not be compromised. No service users should be shaved in the lounge. Daily activities to be improved in line with service users choice. Complete the alterations to the rear garden. Shampoo the carpet in bedrooms 8 & 21 to remove the odour of stale urine. This may need to be carried out daily. Seek advice from the Environmental health officer about the water lying in pipe work in vacant rooms and the risk of Legionella due to this. This is a restated requirement. Contracts must be completed for all staff (contracts relating to past owners of the home are no longer legal documents). Lisnaveane House must provide appropriate contracts for staff. This is a restated requirement. All staff must have training in
DS0000027906.V307442.R01.S.doc Timescale for action 30/10/06 07/08/06 3 4 5 OP12 OP19 OP24 16(2)(n) 23(2)(o) 16(2)(k) 30/09/06 30/09/06 30/08/06 6 OP26 13(3) 30/08/06 7 OP29 17(2) schedule 4(f) 30/08/06 8 OP30 18(1)(a) 30/12/06
Page 25 Lisnaveane Version 5.2 dementia. 9 OP31 9 The manager must be put forward to undertake the Registered Managers Award this year. Once the quality assurance questionnaires have been returned the manager must make an analysis of the information returned and this must form part of the Service Users Guide and be updated annually. 30/10/06 10 OP33 24(1)(a) & (b) 30/11/06 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 OP7 OP24 Good Practice Recommendations Old care plans and risk assessments must be removed from the service users files. The proprietors should consider changing the shared bedrooms into single bedrooms with en-suites. Lisnaveane DS0000027906.V307442.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Lisnaveane DS0000027906.V307442.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
