Inspection on 09/05/05 for Mayfair Avenue (3)

This inspection was carried out on 9th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mayfair Avenue (3) 01/02/07

Mayfair Avenue (3) 26/01/06

Mayfair Avenue (3) 31/01/05

Mayfair Avenue (3) 24/06/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Mayfair Avenue (3) 3 Mayfair Avenue Ilford Essex IG1 3DJ Lead Inspector Jackie Date Unannounced 9 May 2005 14:00 th 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mayfair Avenue (3) Address 3 Mayfair Avenue, Ilford, Essex IG1 3DJ 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) 020 8518 2839 Royal Mencap Society Ms Kathleen Hegarty CRH Care Home 5 Category(ies) of LD Learning disability (6) registration, with number of places Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mild to moderate learning disablilty. Date of last inspection 31st January 2005 Brief Description of the Service: 3 Mayfair Avenue is one of four homes operated by Mencap in the London Borough of Redbridge. The home is situated in a residential street close to Ilford Town Centre. There is easy access to public transport, shops and leisure activities. The home is a large terraced house with four bedrooms, a bathroom with toilet and a shower room with toilet upstairs. Downstairs there is a large open plan through lounge, kitchen, office, staff sleep-in room, laundry area, toilet and one bedroom. The house is well furnished and decorated. The bedrooms are individually decorated and personalised according to residents’ likes and interests. There is also a small well-maintained garden. Five adults with learning disabilities live at the home and they all need a lot of assistance and support from the staff team. Two of the residents have little or no verbal communication and have limited ability to make decisions about their lives. The residents are encouraged to be as independent as possible and have access to day services for all or part of the week. Residents are encouraged to keep in contact with their families and are supported by the home to do this. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection lasted for about four hours and took place during the afternoon. It was the first of the two inspections that each home must have during the inspection year. The manager, deputy, two staff and all of the five residents were spoken to. All of the communal rooms were seen and staff, care and other records were checked. Staff were observed carrying out their duties. What the service does well: What has improved since the last inspection? What they could do better: The manager needs to ensure that the service is running properly and that it continues to develop and that the staff get the support and supervision that they need. Each resident has a detailed care plan but these need to be reviewed regularly to make sure that they contain up to date information. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 6 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. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3 & 4 Information is obtained to enable the staff team to decide whether or not the home can meet prospective residents’ needs. Prospective residents and their relatives can spend time in the home to find out what it would be like to live there. Information is available to enable the staff team to meet residents’ needs. EVIDENCE: The residents have lived together for several years and therefore there have not been any recent new admissions. The organisation has an admissions procedure that includes gathering of information and assessments. It also contains details of how a prospective resident would be introduced to the home. This includes introductory visits. Each resident has a detailed care plan that contains information about what they can do, their likes and dislikes and what help and support they need. Most of the staff team know residents well and know what they can do, their likes and dislikes, what help and support they need and can meet these needs. Residents were observed to be welcomed when they arrived home, offered a drink and asked about their day. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 9 The residents appear to be happy and relaxed in the company of the staff and in the home. Residents that were able to say that they liked living there. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Residents’ plans focus on their individual needs and abilities and contain detailed information so that staff can meet these needs. The residents’ plans and risk assessments are not reviewed often enough and therefore may not contain up to date information about their needs. EVIDENCE: Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 11 Detailed information is available about each resident. This includes information about individuals and their families, their likes and wishes and how they like to be supported. It also contains appropriate photographs. This information has been incorporated into detailed support plans. These are comprehensive and contain clear objectives, e.g. weigh once per month, take for a walk once per day. Outcomes are recorded in daily logs. The degree to which residents can be involved in the development of the plan is limited due to their learning and communication difficulties. Some of the residents’ plans have not been reviewed for more than a year but others have been reviewed within the past six months. The residents’ plans need to be reviewed and updated at least every six months in line with the National Minimum Standards for Care Homes for Younger Adults. Residents and their relatives, social workers must be invited to these reviews. The residents cannot look after their own finances and staff have to help them. Residents can indicate what they want to buy when given choices in the shop and staff support them to do this. There are risk assessments in place. These identify risks for the residents and indicate ways in which the risks can be reduced to enable the residents’ needs to be met as safely as possible. As with the care plans some have been reviewed recently but others have not been reviewed for over a year. These must be reviewed at least every six months in conjunction with the support plans review. Regular reviews of care plans and risk assessments will mean that residents current needs, likes and wishes can be met by the staff team. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 & 17 The residents are encouraged to be as independent as possible, to take part in activities and to be part of the local community. Residents are supported to keep in contact with their relatives. Residents are given meals that they like and that meet their needs and individual preferences. EVIDENCE: All of the residents have access to day services. The amount of day services varies from two days to five days per week. Additionally, they have allocated ‘key days’, when they have one-to-one input from a key worker. This includes visits and activities as well as personal shopping and care of bedrooms. Residents are encouraged to develop their skills and each person contributes to the tasks in the home in as far as they are able. This may be to help clear the table, wash up or put the rubbish in the bin. One resident was observed Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 13 making himself a cup of tea with prompting from staff. Staff spoken to said that residents are encouraged to do as much as they are able and are offered choice in areas of meals, where to go, when to go out and what to wear. All of the residents need support from the staff team when they go out. They visit local pubs, leisure facilities, shops and cinemas. Residents said that they were looking forward to going to the Gateway club on the following evening. Some also said that they enjoyed watching television, particularly the soaps. Residents are asked where they want to go and what they want to do and the staff team also base decisions on their knowledge of individual likes and preferences and how residents respond to new and different activities. Residents are encouraged and supported to keep in contact with friends and relatives. One resident’s mother is very poorly and is no longer able to visit the home and staff regularly take him to see her. On the afternoon of the inspection the manager had taken him to visit his parents. Residents and staff usually eat together. Residents are involved in choosing what they eat and also staff know residents likes and dislikes. Residents said that they had enjoyed their evening meal, which they had during the inspection. One resident has diabetes and the staff team support him to have an appropriate diet. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Residents receive personal care that meets their individual needs and preferences. The staff team support the residents to get the healthcare that they need. Medication is appropriately administered by staff that have been trained to do this. EVIDENCE: The residents require support with their personal care and details of the help that they need and how they prefer to be supported are in their individual plans. Residents are encouraged to choose what to wear. During the week residents are supported to get up in time to attend their day activities but get up when they want to at weekends. All of the residents go to the local doctor and specialist help is received when needed. Staff take residents to all of their medical appointments. Residents’ files have details of health care issues and show that residents have regular access to health care professionals. Records are kept of medical appointments and these show that residents have checks from the optician, dentist and when needed the chiropodist. One resident had been losing weight. The staff team identified this and he was taken to the doctors and a series of checks arranged Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 15 to establish if there was any underlying illness. This resident also has diabetes that is controlled by diet. Records show that the staff monitor this regularly and take the necessary action if any problems arise. For example to give him something to eat or drink and then check again. His diabetes is well managed and controlled by the staff team. None of the residents are able to self medicate and staff that have received medication training to administer medication. The relief staff on duty confirmed that she had been working for the organisation and at the home for several years and that she was trained and able to administer medication. Medication Administration Records were checked and found to be properly completed as required by the previous inspection. However the list and specimen signatures of those trained to administer medication was not up to date and still contains details of people that no longer work at the home. An up to date list and specimen signatures of people trained and authorised to administer medication must be available in the medication file. Medication is securely stored in a locked metal cabinet in the office. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The complaints procedure is in a pictorial format to help residents understand how to complain. Staff are aware of issues of abuse and the need to protect residents from abuse. EVIDENCE: There is an organisational complaints procedure and the staff team have developed a version with photographs for the service users. This includes photos of the manager, service manager and the inspector. This is a very good piece of work designed specifically for the home and exceeds minimum standards. Mencap has produced a detailed adult protection policy that tells staff the actions to take in the event of abuse/suspected abuse being discovered. Appropriate action was taken as the result of a possible adult protection situation. This was fully investigated by the organisation and recommendations from the investigation are being implemented to ensure that best practice is used and that residents are protected from abuse. Staff spoken to were aware of issues of abuse and stated that they had never seen anything untoward at the home. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The residents live in a clean and comfortable home that is suitable for their needs. EVIDENCE: Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 18 The house is in Ilford and is near to the local shops, bus routes and train station. The home is clean and well maintained. The lounge and dining area are combined and the kitchen is open plan. The building is non-smoking. None of the residents smoke. The office and staff sleeping-in room are on the ground floor. There is no separate visitors room but residents can meet visitors in the office if they wish. There is a small well-maintained garden that is used by the service users. There is a toilet on the ground floor and a shower room with toilet plus a bathroom with toilet upstairs. There is a separate utility area with laundry facilities The house is very comfortable and homely and suitable for the needs of the residents. There is also one bedroom on the ground floor, which could be used for someone with reduced mobility but as previously stated the shower and bathing faculties are upstairs. There is no lift in the building. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 & 36 Although the night time staffing arrangements still need to be monitored the staffing levels are sufficient to meet residents’ current needs The manager provides adequate day-to-day support but staff need to receive regular formal supervision. EVIDENCE: Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 20 The staff team have experience of working with people with learning disabilities. Two staff are on duty at peak times. At night there is only one member of staff sleeping in, but with access to support in the event of an emergency. There have not been any reported incidents of shifts not being covered as at the previous inspection. However due to staff absence and a vacancy it has been difficult to cover shifts. The manager and deputy said that they are reviewing the rota and also that recruitment will be discussed with the service manager. At the last visit staff on duty said that some residents are up and about during the night and early in the morning. They also said that they are regularly up during the night to check and support the residents. This was monitored as required by the last inspection and records show that by the end of March the residents were more settled. Staff on duty said that they had not recently experienced any problems during the night. The monitoring had stopped at the end of March but there were still some examples of residents getting up early and the manager was asked to monitor the situation until the end of June and send copies of the record to the Commission. This will enable the sufficiency of the nighttime staffing to be assessed by the Commission. Since the last inspection the manager has returned after a long absence and a deputy is now in post. Therefore the management arrangements are now sufficient as required in the previous inspection. Due to the gaps in the management of the home the staff team have not been receiving regular supervision. The manager said that she and the deputy had very recently attended a supervision training course and that supervision would be starting again. All staff must receive regular formal supervision in addition to day-today contact in order to provide support and guidance and to monitor work with the residents. The previous inspection required that an appropriate systems must be in place to ensure that staff can complete their NVQ’s and also that a minimum of 50 of the staff team achieve at least NVQ level 2 by 2005. The completion date for this requirement has not yet been reached and this will be checked at the next inspection Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 Appropriate management arrangements are in place to ensure that a good quality of service is provided to residents. Although all of the necessary health & safety checks have not been carried out for the last month a safe environment is provided for the residents. EVIDENCE: The manager has a lot of experience of working with people with learning disabilities and of managing residential services. The deputy has been in post for a few weeks and also has a lot of experience of working with people with learning disabilities. From discussions with the manager and deputy it was apparent that they have been discussing the management of the home and have highlighted areas that need to be developed and that they are starting to work on these. The quality of the service provided to the residents is monitored by the home manager and by Mencap. The service manager carries out monthly monitoring Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 22 visits to assess how effectively the home is operating to meet its stated aims and objectives, and reports are robust, indicating the action to be taken when deficiencies are identified. A quality audit was carried out by the organisation. All of the necessary health and safety checks are in place and up until very recently, when a member of staff left, they had been carried out regularly. But arrangements were not put in place for this to continue. The manager and deputy were made aware of this and said that they are going to discuss areas of specific responsibility with the staff at the next staff meeting and will put systems in place to ensure that the checks are carried out. All of the required health & safety checks must be carried out regularly to ensure that a safe environment is provided for the residents. Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 2 3 x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mayfair Avenue (3) Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 24 YES 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 YA6 Regulation 15 Requirement Each care plan must be reviewed with the service user and significant others at least every six months and agreed changes must be recorded and actioned. An up to date list and specimen signatures of people trained and authorised to administer medication must be available in the medication file. Appropriate systems must be in place to ensure that staff can complete their NVQ’s and also that a minimum of 50 of the staff team achieve at least NVQ level 2 by 2005. (Previous timescale had not been reached at the time of this visit.) All staff must receive regular formal supervision in addition to day-to-day contact in order to provide support and guidance and to monitor work with the residents. All of the required health & safety checks must be carried out regularly to ensure that a safe environment is provided for the residents. Timescale for action 31st August 2005 2. YA20 13 31st May 2005 3. YA32 18 30th May 2005 4. YA36 18 31st July 2005 5. YA42 13, 23 15th June 2005 Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 25 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. Refer to Standard None Good Practice Recommendations Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mayfair Avenue (3) G55_S0000025910_Mayfair Avenue_V222166_180405_Stage 4.doc Version 1.30 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. 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