Inspection on 07/01/08 for Marlborough House

This inspection was carried out on 7th January 2008.

CSCI found this care home to be providing an Adequate 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

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Fairfields Country Rest Home

Poldhu

Queensmount

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Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Marlborough House 91-93 Bournemouth Road & 2-4 Marlborough Road Parkstone Poole Dorset BH14 0ER Lead Inspector Amanda Porter Key Unannounced Inspection 7th January 2008 10:40 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 Marlborough House DS0000070348.V357655.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. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marlborough House Address 91-93 Bournemouth Road & 2-4 Marlborough Road Parkstone Poole Dorset BH14 0ER 01202 746761 01202 746761 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) CBS Nursing Care Ltd T/A Marlborough House Nursing Home ****Post Vacant**** Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 52. This is the first inspection of the home under this registration. Date of last inspection Brief Description of the Service: Marlborough House is registered with the Commission for Social Care Inspection to accommodate a maximum of 52 older people with or without nursing needs. It is situated in Parkstone and is close to public transport, shops and churches. The centre of Poole is within easy reach. Accommodation is provided over three floors. There are 10 single rooms with en-suite facilities; 24 single rooms without en-suite; 4 double rooms with ensuite facilities and three double rooms without. There are three dining areas and three lounges situated throughout the house. The home is owned by CBS Nursing Care Ltd. Mrs Shelley Otter, who is not yet registered with the Commission, manages it on a day-to-day basis. Many of the areas of the home have been upgraded and refurbished since the purchase of the property on the 30th July 2007. All areas of the home are accessible by ramps, stairways and a passenger lift. Other mobility aids provided include grab rails, bath hoists and individual mobility aids are in place as required. The weekly fees at the home at the time of inspection range between £475 and £650 per week, extra amounts are charged for chiropody services, hairdressing, daily papers /magazines. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced key inspection was undertaken in line with the Care Standards Act 2000 and following the Commission’s Inspecting for Better Lives guidance. All of the key standards were inspected. This is the home’s first inspection under the new ownership of CBS Nursing Care Limited. The inspection took place on the 7th and 8th January 2008. The new manager, Mrs Shelley Otter and the Operations Manager, Ms Donna Neilson, were on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • The annual quality assurance assessment completed by the home. • 5 surveys completed by residents, 9 by relatives and visitors, 1 by a health professional; 3 by visiting GPs and 3 by staff. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. During the course of the inspection five residents and seven members of staff were spoken with and asked their views on the service provided at the home. Comments received in surveys and through discussion included: “The staff are very professional polite and friendly. I feel the security of the home is reassuring. The surrounding are much improved, very pleasant. The owners are frequently around and ready to answer queries.” “I’ve been well looked after.” “Not all the staff listen to me.” “Support and care has drastically improved.” “The home is now providing a “home-from-home” environment.” “Marlborough House has seen major improvements since the new owners have taken over. The new staff seem to be making a genuine effort to make the home a better place for all. A residents/relatives committee has been meeting every 6 weeks and we are kept informed of any changes and any problems are addressed.” Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Marlborough House was purchased by CBS Nursing Care Limited on the 30th July 2007 and was registered as a new service. This is the first Key Inspection of the home since that date. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Marlborough House DS0000070348.V357655.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 Marlborough House DS0000070348.V357655.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions procedure enables prospective residents, and/or those acting on their behalf, to make informed decisions about admission to the home and ensures that only residents whose needs can be met by the home are offered places there. EVIDENCE: The home’s service user guide was reviewed and it contained sufficient information for prospective residents to be able to make an informed decision about whether they wish to stay at Marlborough House. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 10 In response to the question in the survey “ Do you and/or your friend or relative get enough information about the care home to help you make decisions?” 3 people said “Always” and 5 said “Usually”. One resident said that a member of their family had visited the home on their behalf and had been given a lot of information about it. The files for four residents who had recently moved into the home were inspected. These showed that the home has a good procedure in place. Prior to anyone moving to the home the manager assesses his/her needs. Sufficient information was obtained so that a care plan could be drawn up and made available to staff. The manager confirmed in writing to the resident and/or chosen representative that needs could be met by the home. Marlborough House DS0000070348.V357655.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of nursing care was adequate although the care documentation does not always ensure that staff have sufficient information upon which to base their care practice. The principles of respect, dignity and privacy were put into practise. EVIDENCE: Since CBS Nursing Care Limited purchased the property nursing staff have received training and support to improve the standard of care documentation and this has been monitored by the local Primary Care Trust. As a consequence the standard of care documentation had improved. However there were still some shortfalls in some areas of recording. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 12 Nine care files were reviewed. Files contained a variety of assessments including: • Nutrition, this is in the process of being updated. • Mobility • The risk of pressure sore development • Activities of daily living • Continence. The information from the assessments was used to formulate a plan of care. The goals for care that were set were not always measurable nor did they give realistic expectations. Sometimes there was a delay between an assessment taking place and updating the care plan, for example where there had been a significant weight loss for one resident any alterations in care were not documented. One file, which was reviewed with a member of staff, contained an assessment that identified that the resident was at risk of developing pressure sores but there was no subsequent care plan in place. However staff had ensured the resident had an appropriate pressure-relieving mattress on their bed. Generally the daily written statements in the care files lacked detail about what sort of day the resident has had, how they have been occupied and whether they were in a state of wellbeing. Some care files did identify residents with dementia but daily statements did not routinely mention mental state. Residents and/or their chosen representatives were invited to be involved in drawing up care plans. The care plans were evaluated on a monthly basis Where the need for specialist equipment was identified it was provided. It was clear from discussions with staff and residents that they have access to the health services they need. There was evidence to show that residents get support from General Practitioners, district nurses, clinical nurse specialists, chiropodists and opticians. Medications processes within the home were reviewed with a member of staff. At the time of inspection the medications policy in place was out of date and did not include information on the appropriate methods of disposal of medicines no longer required. A new policy had been completed but not all staff were aware of the contents, for example, the use of homely remedies. Medicines were stored securely. However there was no clear audit trail to identify how much medication was held by the home. Handwritten instructions of the medication administration records had not been countersigned. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 13 Residents and the visitors to the home were generally happy with the care they or their relative received and confirmed that staff treated them with respect and were supportive and kind. Comments received included: “They look after me very well.” “Response to call bell can sometimes be slow.” “I think that information does not always get passed on between trained staff on handover of shift.” “Most of the staff are very good.” “Support and care has drastically improved.” During the inspection staff were observed treating residents with respect, kindness and good humour. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides some individual and group activities and opportunities, which includes links with relatives and family members and respect for individual preferences promoting a good quality of life for residents. EVIDENCE: The home has recently employed a member of staff to organise activities. This member of staff will be undertaking further training so that a wider range of activities will be made available to the residents, which will need to include activities suitable for those residents with dementia. At present the activities include: • Musical entertainment • Crafts • Quizzes • Bingo • Gentle exercises. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 15 One resident said, “We look forward to Bingo.” Residents spoken with confirmed that they could choose how they spent their time but they were not provided with an activities programme, which would have told them what to expect and made planning their routines easier. Residents are able to attend church services if they wish. Visiting clergy are made welcome. There was evidence from residents and visitors that visitors are made welcome at any time and that they are able to spend time privately in residents rooms if wished. One visitor said, “They make visitors feel very welcome”. The home holds resident/relatives meetings and contact with relatives found that they felt this was reassuring and informative. Most rooms viewed were personalised with pictures, some ornaments and items of furniture. Most of the residents spoken with during the inspection said they enjoyed the food provided at the home. However comments received in the surveys returned to the Commission gave differing views. Comments received included: “Some foods are a bit hard.” “The food is excellent.” “The menu options available do not give my relative the choice of things she particularly likes, and do not seem suitable to offer an elderly person who is frail, and also wears dentures.” Residents said that they were consulted about menu choices and the manager confirmed that the menus were in the process of being reviewed. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open approach to the receipt of any concerns, reassuring people that any issues that they may have will be listened and responded to and supporting the commitment to protect people living at the home from harm. EVIDENCE: The home has a clear complaints policy and procedure available to everyone. The Commission for Social Care Inspection have received some complaints and have referred them back to the home to investigate. Documentary evidence was reviewed and showed that this process was done in accordance with the home’s complaints policy. Residents spoken with during the inspection said that if they had any concerns they would feel confident about talking to the manager, knowing that she would listen to them. One visitor said, “They follow up if any concerns have been raised and have acted on them when necessary.” The home has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect and staff have received some training in this. In discussion they appear to have a general understanding of local procedures. Marlborough House DS0000070348.V357655.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Marlborough House has vastly improved and provides residents with an attractive, homely and safe place to live. EVIDENCE: Since purchasing the property the Registered Provider has made many improvements, which include: • Electric profiling beds for all residents. • New bedding, quilts, pillows and towels. • A programme of redecoration and replacement of carpets is well underway. • New front entrance and 3 new exterior doors have been installed. • Several windows have been replaced. • The grounds have been cleared, with the gardens now well maintained. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 18 Residents and relatives said: “The home is always clean and doesn’t smell.” “Great improvements in décor/bed/cleanliness.” “Mr Jaffer has to be commended for the efforts of himself and his staff to provide a comfortable home for all residents.” “The improvements in the environment and care have been dramatic.” Marlborough House DS0000070348.V357655.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient nursing and care staff are employed to meet the needs of residents. Recruitment procedures are robust and protect residents from the risk of unsuitable staff working at the home. Training within the home is not sufficient to enable staff to meet the needs of all residents although there are steps in place to rectify this. EVIDENCE: At the time of inspection staff rosters demonstrated that there are sufficient staff on duty at that time. During the inspection staff were on hand to meet the needs of the residents and call bells were answered efficiently. However some people spoken with during the inspection said that they had to wait to have their call bells answered. The home has an ongoing training programme, which includes NVQ level 2 in care. The manager confirmed that at the time of inspection less than 50 of care staff held this award but there were further candidates who are working towards attaining it. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 20 Five staff recruitment files were reviewed and they contained the relevant information required. The home has recently employed a training officer, who is currently ensuring that mandatory training is available to staff. Sixteen hours a week were allocated to the training officer but she had not been able to utilise them fully over the last month because there was a shortage of staff and she had covered some of the nursing shifts. The home’s chosen method of delivering the majority of training is through the use of video tapes and questionnaires, which may not be a suitable method for some members of staff. Staff files demonstrated that training had been undertaken in the following areas: • Moving and handling • Protection of vulnerable adults • Health and safety • Fire safety • Food hygiene • Infection control. Through discussion with staff it was evident that new staff were receiving some induction training although this was not formerly recorded. The home has a high number of residents with dementia. The training records reviewed showed that staff had not received training on caring for people with this condition and therefore they were ill equipped to ensure that a high level of appropriate care was given. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Marlborough House DS0000070348.V357655.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. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care of residents. EVIDENCE: Mrs Otter has been appointed manager recently. She has not yet submitted her application to register with the Commission for Social Care Inspection. Standard 31 cannot be fully assessed until her application has been processed Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 22 and approved. However staff and residents spoken with confirmed that there was a good working atmosphere under her leadership. She is well supported by the Operations Manager, Ms Neilson. There is an effective quality assurance and quality monitoring system in place. The home takes steps to review its performance regularly and results from audits undertaken are analysed and action is taken as necessary. Residents spoken with during the inspection said that the management team did listen to what they had to say. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The home does hold some “pocket money” for any residents who request this. Clear records are kept of any monies held and how this is spent on behalf of the resident concerned. Records showed that staff had received recent training in fire safety and all had manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and analysed and appropriate action was taken as necessary. On touring the premises with the manager it was noted that staff were not using the hand washing facilities in the sluices and this increased the risk of cross infection. Marlborough House DS0000070348.V357655.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 X 18 3 3 X X X X X X 3 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 X X 3 X 3 X X 2 Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 15 Requirement Timescale for action 08/04/08 2. OP9 13(2) The registered person must, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. (This must include all aspects of physical, psychological and social welfare and give accurate information to staff as to how needs are to be met. Records must also show whether goals set for the care are being met). 08/04/08 The registered persons must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home. The registered persons must: 1. Ensure staff have access and work with an updated policy and procedure, which includes information on the disposal of medication. 2. Ensure that any hand written instructions on the medication administration DS0000070348.V357655.R01.S.doc Version 5.2 Marlborough House Page 25 records are countersigned. 3. Ensure staff are aware of and adhere to the home’s “homely remedy” procedures. 4. Ensure that there is a clear audit trail of any medications entering or leaving the home. 3. OP30 18(1) The registered persons must 08/04/08 ensure that all staff receive training appropriate to the work they are to perform, including dementia training. Structured induction training must be provided for new staff and recorded appropriately. The registered person must 08/04/08 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. (Staff must use appropriate hand washing techniques.) 4. OP38 13(3) 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 OP12 OP28 Good Practice Recommendations A copy of the activities programme should be made available to each resident so that they can plan their day accordingly. A minimum of 50 of care assistants should hold the NVQ level 2 Award in care. Marlborough House DS0000070348.V357655.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Marlborough House DS0000070348.V357655.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!