Inspection on 17/04/09 for Lyncroft

This inspection was carried out on 17th April 2009.

CQC found this care home to be providing an Good service.

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

Lyncroft 05/06/08

Lyncroft 02/08/06

Lyncroft 06/10/05

Lyncroft 03/05/05

Lyncroft 07/10/04

Lyncroft 13/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Name: Address: Lyncroft 237 Banstead Road Banstead Surrey SM7 1RB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector:     Date: This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Page 3 of 27 Information about the care home Name of care home: Address: Lyncroft 237 Banstead Road Banstead Surrey SM7 1RB 02087868381 02087868381 bansteadrd@walsingham.com www.walsingham.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Walsingham care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Lyncroft is a residential care home that was first registered in January 1997 to provide care for people with learning disabilities. Over recent years there has been a period of uncertainty as the future of the home was unclear. The home has a clearer direction and focus now; it will be providing an interim home to people who have recently been discharged from Orchard Hill Hospital (a long stay hospital for people with learning difficulties in the London Borough of Sutton) and Page 4 of 27 Over 65 0 5 Brief description of the care home preparing them for supported living accommodation in the community. This homes ethos is based on Christian philosophies. The home is one of four homes in the Croydon and Sutton area that are owned by `Walsingham, which is a registered charity. Lyncroft is a two storey detached property in keeping with the other houses in Banstead Road. The property lies between Banstead and Ewell; it cannot be accessed easily by public transport, with a train station ten minutes walk away and no bus links. The costings for the year 2009/10 range from £1,689 to £1,726 per week. The costings reflect the level of needs of the individuals placed into the home; placing authorities are advised to contact the home directly to get a full menu of costs. Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which started at 9.15 am. and took approximately five hours to complete. during this time we had a tour of the building, discussions with staff, looked through documentation relating to people who use the service and to the running of the home. There was limited opportunity to share views with the people who use the service. This is because the three people currently living in the home do not have verbal communication. Instead, we looked at interactions between staff and people who use the service we also examined the questionnaires completed by people who use the service. These questionnaires were positive. We viewed all documentation relating to the service, which had been received by the Commission in the preceding year. This included a document called an Annual Quality Page 6 of 27 Assurance Assessment, which is a self-assessment of the service completed by the manager. The home has been in a period of flux of some considerable time. Meetings have taken place over a number of years between the managers of Walsingham and representatives of the Local Authority to consider the direction of the service. Now decisions have been made about the home, it is envisaged that there will be a period of stability. We would like to thank the people who use the service and staff who made themselves available during the inspection. What the care home does well: The home ensures that the needs and wishes of people who use the service are paramount. There are many examples of good practise, which can be highlighted as evidence of this; These range from day to day choices, when to eat and where to go on holiday. Staff are well trained, and generally have the knowledge and understanding to provide people who use the service with a good standard of care. People who use the service are at the heart of their ethos, and all activities are arranged with this in mind. Walsingham are committed to ensuring that their workforce has a solid foundation during their induction period; and that staff then undertake regular training in order to improve their knowledge and skills. This was evident as staff were all able to communicate effectively with people who use the service even though they had very different communication patterns. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home gathers a lot of information about any potential new person coming into the home. Therefore the home has a full picture of the individual and their needs, and is only providing a service to those whose needs it can meet. Evidence: The home has been in a period of flux of some considerable time. Meetings over a number of years between the managers of Walsingham and representatives of the Local Authority have considered the future of the home and the people placed there. A decision was taken approximately a year ago that Lyncroft would be a home for people with learning difficulties and challenging behaviours who had previously been placed at Orchard Hill long stay hospital. With this in mind, the two people who had lived in the home have now moved on, and been replaced with three new residents. It is envisaged that the home will eventually have five people living there the number it is registered for. We examined the documents relating to two new people coming into the service. The Page 10 of 27 Evidence: process by which this happens is that an assessment is received from the placing borough. The homes manager then meets the prospective new person two or three times in their existing home, during which time the manager would complete Walsinghams own assessment. There are then a minimum of three transitions meetings held with the placing authority these have input from other professionals such as occupational therapists and psychologists. Once these meetings have taken place, introductions to the home begin. We noted that individuals coming into the home have number of visits including overnight stays. a review meeting is held prior to the final decsion being made about a placement within the home. Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have care plans drawn up from comprehensive assessments. In general, these care plans are detailed and well written, people who use the service are involved, as are their representatives so that they reflect the needs of the people who use the service. Evidence: We case-tracked two people who use the service and there were full assessments in both cases. This included information from other professionals and Walsinghams own very detailed assessment. the assessment had then been translated into a detailed care plan outlining the individuals daily activities, this included risk assessments. In one example, there were fourteen risk assessments which included washing hair, cleaning teeth and taking a bath. the care plan had been written in September 2008 and was reviewed in March 2009. Risk assessments were also reviewed regularly; therefore a requirement made Page 12 of 27 Evidence: at the previous inspection is deemed to have been met and is therefore withdrawn. In addition to reviewing the documentation, there was evidence that the home had had regular review meetings with Social Services to monitor the placement people who use the service are invited to these meeting, as well as their representatives. All of the people who use the service have an independent advocate that visits on a regular basis and attends various meetings Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are offered the opportunity to participate in a range of activities, dependent upon preferences Dietary needs are catered for with meals based on peoples choice of likes and dislikes, providing them with daily variation and healthy eating options. The daily routines and house rules promote rights and encourage independence. The home has an open visitors policy to ensure friendships and family links are maintained. Evidence: People who use the service each have their own activities timetable which is called a commitment plan; these plans have been developed by the staff, and are based on each persons preferences and wishes. Page 14 of 27 Evidence: We viewed all the plans, and noted that people had a range of activities including going out for a meal, playing football and tidying their bedroom. On the day of the inspection one person went to the local shopping area for a coffee, and another was planning to go the cinema in the evening. We noted that all three people who use the service went on holiday to Centre Parks in January. There was a telephone discussion with the manager as to why everyone had gone on the same holiday. The manager stated that because of decoration to the home, the decision was taken that the premises needed to vacated. We were assured that all people who use the service will be offered another holiday in the summer; one person had really enjoyed Centre Parks and would be returning, another would be going abroad and a decision was yet to be made about the final person. With regard to meals, we looked at the menu which was completed a week in advance. We had a discussion with staff about the process of choosing meals; they stated that with breakfast decisions could be made easily, as options were laid out for people. However, it was much more difficult for evening meals, the home had attempted to use pictorial images of food but found that people who use the service were not really looking at the pictures. Instead decisions about food choices were made on the basis of trail and error. People who use the service are encouraged to participate in the shopping and preparation of the meals. people who use the service were observed helping themselves to drinks. available. All people who use the service have their own independent advocate who visits regularly and attends meetings People who use the service are given a choice of having keys to their bedrooms and the front door of the home. There is also a lockable space provided in their bedrooms. Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care is carried out in a way that people who use the service have their dignity and choice maintained. The recording and administration of medication needs to be improved so that it does not compromise the safety and welfare of people who use the service. Evidence: The way in which people who use the service prefer to receive their personal care is recorded on their files. The designation of a key worker also allows for consistency and continuity of care. The people who use the service also have monthly one to one sessions with their key worker, notes of which were available for inspection purposes. One member of staff was asked about issues of privacy and dignity and their responses indicated that they had an appropriate awareness and understanding of the issues. With regard to health records, information is recorded for every visit detailing the outcomes; These records were examined and appeared up to date and accurate. Page 16 of 27 Evidence: Appointments that were kept included podiatry, opticians and doctors appointments. The home stores all medication in a locked metal cabinet in the office. The home receives much of its medication from the pharmacist in dossette packs on a monthly basis. The home receives a pharmacist audit on a regular basis. At the previous inspection it was noted that a person using the service had not received their required medication as they had gone out for lunch. Two requirements were made at that stage; firstly, that prescription medicines must be administered at the required time and secondly, that the home must review its medication policy in order to avoid such an incident occurring again. We note at this inspection that the previous requirements had been actioned and are therefore withdrawn. However, whilst examining the Medication Administration Records (MAR) sheets it was noted that there were a number of omissions in the recording on two of the three files. These omissions could compromise the well being of people who use the service as it could lead to overdosing of medication, or in this case, anti-epileptic and anti-psychotic medication being missed all together. A requirement has therefore been made in this regard. Whilst checking staff training it was noted that two members of staff who had recently transferred from another home had not had their medication training within the timescales required. For one member of staff the training was out of date by a matter of weeks, for the other member of staff however, it was by almost a year. This issue was raised with the manager who was able to provide evidence that she had the matter in hand and that the error had occurred as the staff members had transferred from another home. Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is complaints policy and procedure, which facilitates good access to the complaints system for people who use the service, their family or their representatives. The home has the appropriate policies in place to ensure the protection of vulnerable adults. Evidence: The complaints procedure was clear and contained all of the elements required to meet standard 22 including a minimum response time of less than 28 days. The complaints procedure is also in picture format and clearly displayed in a number of places within the home. The home has a complaints log; within the last year there were four entrys however, they all refer to maintenance and repairs to the home. We had a discussion with one member of staff regarding adult protection and the whistle blowing policy. From the response it was possible to ascertain that there was an understanding and awareness of the procedures and action that maybe required. All staff have had recent training regarding vulnerable adults and Deprivation of Liberty Act. Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general the decor of the home is good, providing a comfortable environment for people who use the service to live in. Bedrooms provide privacy and reflect individual interests and preferences. Evidence: The home is a detached house on a residential road. It is close to Banstead train station, but local amenities can only be accessed via car. The homes premises are in keeping with the local community and are suitable for their purpose. On the ground floor there is a large communal lounge with access to an integral garage; the access to the garage was locked, this was a requirement from the previous inspection. Additionally, on the ground floor, there is a dining room, kitchen, laundry room, two bedrooms and one bathroom. On the first floor there are a further three bedrooms, two bathrooms, a sleeping in room and an office. It was noted that although secondary glazing had been fitted to all the windows; some Page 19 of 27 Evidence: windows still need to be fitted with restrictors. To the rear of the property, there is a mature garden, which can be accessed via French doors from the lounge. The home has purchased new garden furniture, which is being used in a recently developed seating area. There is a garden pond, which has been fenced off. There are separate laundry room with facilities that can wash clothes at a temperature which would control the risk of infection. The premises were generally clean, bright and airy. A number of requirements made at the last inspection in relation to the environment had all been acted upon. Each person using the home has a single room, which has been decorated to reflect their individual taste. The furniture is domestic in style and of good quality. We were only given permission by one person to view their bedroom, although we were able to look at vacant bedrooms. Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team at the home have a range of skills and abilities, which enable them to meet the needs of people who use the service. Staff receive levels of training and support through supervision so that the calibre of staff remains high so that they continue to understand the needs of the people who use the service. Evidence: The current arrangements for staffing at the home are two staff on an early shift, and two on a late. There is one waking night staff and one sleeping in. Staff rotas were checked at random to ascertain the staffing levels at any given time; the rotas confirmed the level of staffing. The composition of the staff team has changed quite dramatically from being an all female team to being approximately half. This is seen as positive, as there are currently three males living in the home. Walsingham offers ample training opportunities to staff at all levels. New members of staff complete an induction programme covering various subjects including health and Page 21 of 27 Evidence: safety, fire drills, and introductions to people who use the service. The induction programmes are signed, dated and kept on staff files. We had the opportunity to speak to one member of staff who was still on their induction; they were shadowing a colleague and supernumerary to the staffing levels. This member of staff appeared to be well equipped with knowledge about the job and what it entails. Records of training are kept both within the home and centrally. Records were checked for three individual members of staff and showed that they had completed the requisite number of days training. Information from the home indicated that the levels of National Vocational Qualifications training have dropped quite significantly, with only two people having completed their NVQ and one person currently undertaking it. The home need to keep these levels under review. Recruitment records are all held centrally by Walsingham these were checked on the 16th March 2009 by senior person within CSCI and found to be satisfactory. There were no recruitment records available at the home for inspection. Supervision records were not available, as the manager has them locked away; We were however, able to discuss the frequency of supervision levels with staff, they were able to confirm that supervision is taking place at on a monthly basis which is higher than the required level. Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general, the home has adequate arrangements for ensuring the health and safety of people who use the service and of the staff. The lack of a permanent, registered manager could in due course affect the standard of the care provided by the home. Evidence: The homes current manager has been post since November 2008, Ms Lyanna Mesure is not yet registered with the Commission. A recommendation has therefore been made that home should register a manager for the service as soon as in practicable. People who use the service had completed Walsinghams own questionnaires; the questionnaires had been written specifically for people with learning difficulties and comprised of pictures and tick boxes. The results of the surveys were all positive. The Walsingham group have a legal responsibility to complete Regulation 26 visits every month and have copies available for inspection purposes. The regulation 26 Page 23 of 27 Evidence: visits are an internal audit by a person not directly responsible for running the home, as a way of ensuring quality; Copies of the regulation visits were available for the recent months. Documentation relating to health and safety were checked. Portable Appliance Testing was completed on the 14.11.09; gas certificate was obtained on the 2.10.08; Legionella test was carried out on 2.12.08 and fire systems were checked on the 27.3.09. Fire testes were conducted on weekly basis. Fire servicing was completed on the 1.2.07 and there was recording of weekly fire checks. Fire drills were undertaken on a regular basis. A first aid box and a fire blanket are situated in the kitchen. The first aid box was examined and a number of expired items were found, for example a mouth to mouth resuscitation item expired in August 2006. A requirement has been made that all out of date items from first aid boxes must be removed and that there must boxes must be regularly checked. Fridge and freezer checks were examined, they showed that checks were undertaken on a daily basis. An out of date food item was found, this was disposed of at the time of inspection. However, a requirement has been made that the home must ensure that out of date food items are withdrawn so that they do not affect the health of people who use the service. Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered person must ensure the correct recording of medicines received into the home. This is to ensure the safety and well being of people who use the service. 23/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 The registered person should ensure that staff all undertaken refresher training within the appropriate timescales. The registered person should ensure that all first floor windows are fitted with restrictors. The registered person should ensure that it keeps the levels of NVQ under review. The registered person should ensure that the home has a registered manager. 2 3 4 24 32 37 Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Page 27 of 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!