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Inspection on 12/07/05 for Longbridge Deverill House

Also see our care home review for Longbridge Deverill House for more information

This inspection was carried out on 12th July 2005.

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

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

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

What the care home does well

The residents spoken to commented very positively about the care and services provided. Residents commented that they were very happy with the quality and quantity of food available, the laundry arrangements and the care provided by the staff. Residents` specific comments are reflected within the main body of this report. The health care needs of the residents are being suitably met. Residents are treated with respect and their rights to privacy are upheld. Residents are provided with the opportunity to pursue their own individual interests as well as being able to participate in the various organised activities arranged by the home. Residents are enabled to exercise choice and control over the various aspects of their lives with the support of staff, where required. Residents have confidence in the arrangements for making complaints and feel that any concerns they may have would be listened to and appropriately acted upon. The home is maintained to a good standard being clean, tidy, and comfortable and provides sufficient lighting, heating and ventilation. The decoration and furnishing and fittings are also suitably maintained.

What has improved since the last inspection?

The home continues to make physical improvements to enhance the residents` living environment. The home has continued to review its various systems including monitoring its quality control.

What the care home could do better:

Further improvements are planned to enhance the residents` living environment, which includes the redecoration of the quiet lounge and the replacement of one of the lifts. The home intends to review the roles andresponsibilities to ensure that staff receive the frequency of formal and recorded supervision required by the national minimum standards.

CARE HOMES FOR OLDER PEOPLE Longbridge Deverill House Church Street Longbridge Deverill Warminster Wiltshire, BA12 7DJ Lead Inspector Thomas Webber Unannounced 12th July 2005 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 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. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Longbridge Deverill House Address Church Street Longbridge Deverill Warminster Wiltshire BA12 7DJ 01225 782019 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Equality Care Ltd Jean Proctor Care Home Only 27 Category(ies) of DE(E) Dementia - over 65 (3) registration, with number LD(E) Learning Disability - over 65 (2) of places OP Old Age (27) PD(E) Physical Disability - over 65 (1) Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at any one time is 27. 2. Not more than 1 service user aged 65 years and over with a Physical Disability may be accommodated at any one time. 3. No more than 2 service users aged 65 years and over with a Learning Disability may be accommodated at any one time. 4. No more than 3 service users aged 65 years and over with Dementia may be accommodated at any one time. Date of last inspection 16th December 2004 Brief Description of the Service: Longbridge Deverill is a private residential home offering accommodation and personal care to a total of 27 service users over the age of 65 who require care primarily through old age, although the home is also registered to accommodate 3 service users with dementia, 2 with leaning disabilities and one with a physical disability within the overall total. The home is registered under Equality Care Limited and the registered manager is Ms Jean Proctor. The home is a detached 300 year old listed building, which has been extended several times and is situated on the busy A350 in the village of Longbridge Deverill between Warminster and Shaftesbury. There is a railway station in Warminster and the A303 is about a ten minute drive to the south of the village. The home is located close to limited local amenities and there is a bus stop immediately outside the entrance to the home and car parking facilities are available to the front of the property. The home provides all single bedrooms for residents’ use. However, there are two shared bedrooms, which would only be used as a shared facility for married couples or relatives who wish to share. All, apart from one single bedroom, are provided with en-suite facilities. Service users’ bedrooms are located on the ground and first floor levels. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, undertaken during the course of one day from 09:30 to 13:40. The main purpose of this inspection was to obtain the views of the residents regarding the care and services provided by the home. These were ascertained in conjunction with a tour of the premises and the views of twelve of the twenty-two residents, in situ, were sought on an individual basis. In addition to a number of the standards being assessed, records in relation to the home’s contracts, assessments, medication, complaints, menus and staff rotas were also checked. What the service does well: What has improved since the last inspection? What they could do better: Further improvements are planned to enhance the residents’ living environment, which includes the redecoration of the quiet lounge and the replacement of one of the lifts. The home intends to review the roles and Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 6 responsibilities to ensure that staff receive the frequency of formal and recorded supervision required by the national minimum standards. 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. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 5 and 6 Residents are provided with a copy of the home’s written contract or placing authority’s terms and conditions. All residents are assessed, usually prior to admission, to ensure that the home can meet their needs. Opportunities are available for prospective residents and their families to visit the home, prior to admission, to assess the quality of facilities and suitability of the home EVIDENCE: All residents are provided with a copy of the home’s contract however, where residents are funded by social services, they would also be provided with a copy of the relevant local authority’s statement of terms and conditions. Evidence was available to confirm that one of the two residents recently admitted to the home and case tracked by the inspector had been given a copy of the home’s contract. The other resident was admitted as an emergency placement for respite care and will be provided with a copy of the relevant local authority’s statement of terms and conditions, usually, after four weeks after admission. The proprietor has agreed to provide the resident with a copy of the home’s supplementary contract if this is not received within the fourweek timescale. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 9 The home’s pre-assessment tool is completed regardless of whether residents are funded privately or by social services. This is normally achieved prior to admission and is undertaken wherever the resident is accommodated at the time. In addition, the home would normally obtain a copy of the community care assessment or other relevant information in relation to those residents funded by social services. Documentary evidence was available to show that the home’s pre-assessment tool had been completed in relation to both of the most recent admissions to the home and case tracked by the inspector. However, the assessment was completed two days after admission in respect to one of the residents due to the nature of the admission. A copy of the community care assessment had also not been received in respect to this resident who is funded by social services. Opportunities are available for prospective residents and their families to visit the home as many times as they wish, prior to admission. As part of the introductory process, residents and their relatives are given the opportunity to meet with staff, other residents, tour the premises and ask any questions relating to the running of the home. The manager reported that one of the residents and her family visited the home prior to admission whilst only the family visited in relation to the other resident. The home’s contract also confirms that residents are given a four-week trial period, although this timescale can be extended. The home does not provide intermediate care, therefore this Standard is not applicable. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 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 standard(s) 8, 9 and 10 Residents’ health care needs are being suitably met and staff have a good understanding of their responsibility when administering medication. Resident’s privacy and dignity are respected at all times. EVIDENCE: Residents are registered with either of the two practices within Warminster and residents tend to visit the surgeries for any appointments, with the support of staff, unless they are too ill to do so. Transport, by way of taxis, is provided for this purpose by the home. The district nurse visits twice a week and sees and provides any treatment to residents in the privacy of their bedrooms. The manager reported that an excellent rapport exists between the home and the district nurses. Residents confirmed they can and do access other health care services such as dental, opticians and chiropody as and when required. Appropriate aids are provided for those residents who require them for incontinence and mobility. Appropriate systems have been established for the receipt, storage, administration and return of unwanted medicines. Examination of residents’ drug sheets showed that they are being appropriately initialled for medication administered. The manager reported that none of the residents are currently self-medicating. However, residents who are deemed capable and following a Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 11 risk assessment could maintain control over their medication and suitable storage facilities would be provided for this purpose. Staff only administer medication to residents once they have received full training from the manager. The manager reported that some staff have also received external training in the administration of medication. Residents are provided with their own single bedroom where they can conduct all their personal affairs in complete privacy, including medical examinations and any treatment. There is a telephone room where residents can make and receive telephone calls in complete privacy. Residents can also have a telephone installed in their bedrooms and some of them have availed themselves of this facility. Residents’ mail is given directly to them unopened unless they are unable to deal with it themselves. In these circumstances, their relatives or the home would deal with residents’ mail. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 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 standard(s) 12, 14 and 15 Opportunities are available for residents to pursue social, religious and recreational activities. Residents, within their capabilities, can exercise personal autonomy and choice. Residents receive a varied, appealing and balanced diet and meals are taken in a congenial setting. EVIDENCE: From observations and discussions with residents, it is apparent that they can choose where and how to spend their time, including rising and going to bed. Residents have the opportunity to pursue their own individual interests as well as being able to participate in the various organised activities arranged by the home should they so wish. A hairdresser visits weekly and the Church of England vicar visits monthly. Observations and discussions with some residents confirmed that they can exercise personal autonomy and choice. Residents can and have brought items of furniture and personal possessions to make their bedrooms more homely. They can choose what time to get up and go to bed, how and where to spend their time, where to eat, and what activities to participate in. Residents, who are capable, can also handle their own financial affairs in the privacy of their own bedrooms. A satisfactory and varied four weekly menu is in operation, which provides a choice at breakfast time with set meals at lunch and teatime. However, Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 13 alternatives are provided for these meals if required to meet the preferences of the residents. A cooked breakfast is provided for those who wish it. Residents’ dislikes are sought and recorded on admission. Drinks and snacks are also available at other set times of the day. Although residents are encouraged to use the dining room for their main meal as part of socialisation, they could choose to eat all their meals in their bedrooms if they so wish. Residents spoken to, commented favourably with the quality and quantity of food provided, confirming that the home provides a variety and they receive plenty of food. However, a couple of residents did comment that the food did vary on occasions. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 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 standard(s) 16 and18 Information is provided to residents on how to complain should they wish to and residents are confident that any complaints/concerns would be listened to, taken seriously and acted upon. Appropriate procedures are in place to protect residents from abuse. EVIDENCE: A satisfactory complaints procedure has been established by the home and a copy of this procedure is displayed on the notice board within the home. Since the last inspection the home has not received any formal complaints. The home encourages residents to express any concerns, however minor, about the care and services provided. Seven concerns have been received with four being upheld, one being partly upheld and two not being upheld. Records showed these concerns have been responded to promptly and suitably resolved. Those residents spoken to commented that they had no complaints or concerns. However, if they did have any, they felt confident in discussing them with the manager and staff who would listen and act accordingly. The home has appropriate procedures for responding to suspicion or evidence of abuse and has obtained a copy of the Department of Health Guidance “No Secrets”. In addition, copies of the shortened version of the Wiltshire and Swindon Vulnerable Adults procedures, which are in line with the Department of Health guidance document have been obtained and been distributed to all staff. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24 and 26 The home is accessible, safe and suitably maintained to meet the residents’ individual and collective needs. Residents are provided with their individual bedrooms which they have personalised to their individual wishes. Residents have access to a number of toilet and bathroom facilities. The home is maintained to a good standard being clean, tidy and comfortable and provides suitable laundry facilities. EVIDENCE: The building complies with the requirements of both the local Fire and Environmental Health Officers’ departments. The home has an on going programme of maintenance to enhance the residents’ living environment and a number of improvements have been carried out since the last inspection. These include the refurbishment and redecoration to some service users’ bedrooms and to the kitchen. Due to the layout of the premises, the home provides two passenger lifts and a stair lift to enable residents to access all parts of the building. A call bell system is installed in each room, which can be used by residents to call for staff assistance. There is a spacious, safe, well Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 16 maintained and accessible rear garden, which is used and appreciated by the residents, weather permitting. The home provides sufficient communal space to meet the needs of the residents. These consist of two large lounges, one of which is still due to be redecorated in the near future, and a separate dining room. The range of facilities provide the option for a variety of activities to take place as well as providing residents with a choice of where to sit. The communal rooms are suitably furnished, providing a combination of domestic and natural lighting. The home provides sufficient bathroom and toilet facilities, which meet the needs of the residents, as well as the national minimum standards. The facilities include a hydrotherapy bath, which the manager reported is rarely used by the residents. The home provides all single bedrooms for residents’ use. However, there are two shared bedrooms, which would only be used as a shared facility for married couples or relatives who wish to share. All, apart from one single bedroom, are provided with en-suite facilities, consisting of at least a toilet and wash hand basin. Residents spoken to commented positively about the standard and cleanliness and the level of accommodation provided. Residents’ bedrooms are suitably furnished and equipped to ensure comfort, privacy and to meet their assessed needs. Residents can and have brought items of furniture and personal possessions to make them more homely. Locks have been fitted to residents’ bedroom doors where this has been requested, based on a risk assessment. In addition all residents’ bedrooms have been or are in the process of being provided with a lockable storage space, which consists of either a safe or a lockable cupboard. The home continues to be maintained to a good standard being clean, tidy and comfortable. The laundry room is located on the ground floor and provides suitable facilities to meet the needs of the home. Residents’ clothing is labelled to ensure that garments are appropriately returned and laundresses are employed to undertake the washing and ironing with some support of the waking night staff. Service users commented favourably about the laundry arrangements in place, stating that their clothing is returned in good condition. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 and 29 The home continues to provide sufficient numbers of staff on duty at all times to meet the needs of the residents and continues to work towards achieving a trained workforce in line with the National Minimum Standards. The residents are supported and protected by the home’s recruitment practices. EVIDENCE: The home ensures that there is sufficient staff deployed by providing four members of care staff on duty in the mornings with three members of care staff on duty in the afternoons and evenings. There are two waking night staff on duty each night together with a member of staff sleeping in. Staff were observed undertaking their duties in a caring and attentive manner. Residents spoken to commented positively about the care provided stating that the staff are excellent, kind and first class. The home continues to support staff in either achieving or working towards completing NVQ training at various levels. A sample of files for two newly appointed staff were checked and showed that appropriate recruitment practices are, in the main, being followed. However, the home could benefit from ensuring that a full employment history is obtained, where possible, and any gaps are explored and the reasons recorded. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Monitoring systems have been established which includes effective communication to ensure that staff are kept up to date and are supervised. EVIDENCE: There are a range of mechanisms in place for the manager to both brief and receive feedback from staff in order to monitor the standard of care and services provided to the residents and to ensure that staff are kept up to date. These include daily handover meetings/reports, quarterly staff meetings, and observational supervision as well as formal and informal staff supervision. The manager reported that staff appraisals for staff have nearly been completed. The manager also reported that she is in the process of re-allocating some staff roles to ensure that the frequency of formal and recorded staff supervision for this Standard is achieved. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x x Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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 29 36 Good Practice Recommendations The registered individuals should consider ensure that a full employment history is obtained, where possible, and any gaps are explored and the reasons recorded. The registered individuals should ensure that all staff receive regular and formal and one to one supervision. Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB 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 Longbridge Deverill House D51_D01_S57131_LONGBRIDGEDEVERILL_V214220_130505_Stage4.doc Version 1.30 Page 22 - 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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