Inspection on 17/09/07 for Markham House

This inspection was carried out on 17th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Markham House 11/02/09

Similar services:

The Manor House

Applegarth

Thornham Grove

Hunter`s Lodge

Conifer Lodge

Manor Court

92 Black Prince Avenue

Agnes House

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

CARE HOME ADULTS 18-65 Moorfields 80 Moorfield Avenue Bolsover Derbyshire S44 6EL Lead Inspector Bridgette Hill Unannounced Inspection 17th September 2007 09:20 Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 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 Moorfields DS0000069511.V340905.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 Adults 18-65. 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. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorfields Address 80 Moorfield Avenue Bolsover Derbyshire S44 6EL 01246 822285 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) chesterfieldabi@yahoo.co.uk Voyage Ltd Position Vacant Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13), Physical disability (13), Sensory of places impairment (13) Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Voyage Ltd may provide the following category of service only: Care home - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - code MD. Physical Disability - code PD. Sensory Impairment - code SI. The maximum number of service users who can be accommodated is 13. First inspection since registration 2. Date of last inspection Brief Description of the Service: Moorfield avenue is a purpose built care home that specialises in proving personal care for service users with acquired brain injury. Nursing care is not provided at the home. 11 bedrooms are located in the main part of the building and bedrooms have varying facilities including 3 bed-sit type rooms with a separate lounge/kitchenette area. All bedrooms have large en suite shower rooms. In the grounds of the home are two bungalows which provide facilities for service users to be supported by staff whilst living largely independently. The home is built and furnished to a very high standard and has a large well tended garden with seating area. The home is located in a residential area approximately 10 minute walk from the centre of Bolsover. Some local shops and pubs are nearby. The fees charged at the home are £1350.00 per week. This information is included in a pack which is provided for all service users. A range of information is provided to service users in an easy to read format accompanied by pictures. Healthcare information leaflets are also available for service users on a range of topics. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit which focused on assessing all key standards. As part of the inspection a sample of service users care files and a range of documents were examined. A tour of the building was conducted. During the visit opportunity was taken to have discussions with management, staff and service users. An Annual Quality Assurance Assessment was completed by the provider prior to the inspection and considered as part of the inspection process. The person in charge at this visit was the Acting Manager Michelle Watson What the service does well: What has improved since the last inspection? What they could do better: The home is in the early stages of development having been opened for less than 6 months. Significant work had been completed in this time to ensure standards were met. There was scope to formalise and improve and formalise the review system for care plans and explore community educational facilities for service users. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 6 Where medications records were handwritten some poor record keeping was evident. Thus included a spelling error and lack of instructions regarding dosage, frequency and maximum limits. Complaints records need to record the dates that complaints were resolved. It was recorded what actions had been taken which was found to be appropriate but it was not possible to audit timescales. 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. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The needs of service users are appropriately assessed prior to admission and service users have opportunity to visit the home prior to be admitted. EVIDENCE: The home has been registered in the past 6 months and formally opened in April 2007 Therefore all service users were relatively new to the home. The assessment process was discussed with the Acting Manager who said that all prospective service users were assessed prior to admission. This was evidenced by a typed assessment in one service users file. Care files seen also contained additional information from Care Managers or other professionals who may be involved in service users care. Service users spoken to said they had been given opportunity to visit the home before moving in. Some service users said they had looked around and chosen their room, others said they had preferred just to move in. All service users reflected positively on the decision to move into the home comparing it positively to other experiences of care settings. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans were in place that described service users assessed needs, risks and limitations and detailed how staff were to meet these. EVIDENCE: Two service users care files examined these contained personalised plans of care which included consideration of healthcare needs, if assistance was required with budgeting and consideration if service users were able to self medicate. Care plans included details of where service users were involved in daily tasks such as cooking or cleaning their own rooms. Care plans detailed that service users should be encouraged to take part in activities and advocated giving choices to service users. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 10 Generally the care plans in place were found to be personalised and advocated positive approaches by staff towards encouraging service users to improve the independence and motivation of service users. A weekly summary of service users was completed as well as log entries with staff recording an entry for each assessed need on the care plan as well as an overview. Formal reviews with other agencies were planned to take place within the next two weeks. The Acting Manager said systems for reviewing care plans on a monthly basis had not yet been implemented but were planned. Service users said staff ‘treated them like a person’ and Service users spoken with were able to name their key worker and said they had seen their plan of care. The service users had signed all care plans seen. Service users spoken with said they talk easily to staff at the home and staff helped them with the things they couldn’t do. There were formats available for recording identified risks in the environment and outside of the home. Where limitations were in place these were found to be recorded. This included where service users need staff support to go out, or risk of fire from cigarette smoking. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides personalised care for service users with flexible routines and choices to service users with encouragement and support given by staff to enable them to develop skills and independence. EVIDENCE: The home had a car which was used to transport service users to appointments and other outings such as shopping trips. Service users spoke about flexible mealtimes and getting up times saying they went to bed ‘when they liked’. Service users appeared to take care of their appearance and said they went shopping for clothes with staff. Some staff used local shops independently others were supported to go out when they wished. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 12 Some activities were regularly arranged in the home such as quiz nights and video’s. Service users records and discussions with them indicated that there was regular family contact for some service users. A compliments book in the entrance hallway had been completed by two relatives who were happy with the care received by their relatives recording that ‘the place is more than I expected’ and that one relative was ‘impressed by the dedication of staff’ The fees payable included an annual holiday but do to service users having recently being admitted to the newly home this had not yet been organised. Initially an overnight break was being considered. Service users said they actively consulted on the menu for the week and were involved in shopping for the food. Some service users spoken with were aware of the importance of healthy eating. Occasional takeaway meals were enjoyed. Service users said they were involved in some daily living tasks in the home such as laying tables, washing up and general tidying. Staff ate meals alongside service users to encourage the social aspect of eating and sharing a meal. Service users were encouraged to become involved in cooking to varying degrees according to abilities. Some service users used the kitchen in their rooms to largely cater for themselves with support given as required to plan menus and buy ingredients. Where service users participated in daily living activities these were included as part of the care plan. A communal cooking session was held weekly. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The healthcare needs of service users was assessed and were met with staff support if this was required. The recording of medications by staff had shortfalls which have the potential to adversely affect service users. EVIDENCE: Routines for service users were recorded and were personalised. An overview of the activities for the week was included in care files. Care records were available where service users had visited the GP or outpatients appointments. Care records evidenced that service users were supported to go to appointments such as dentists and for other health issues. All service users were registered with one GP practice and nursing care if required would be provided through the district nursing service. The storage and administration of medicines was examined. A monitored dosage system is used at the home and the storage was found to be acceptable. Records of medications received into the home and returned to the Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 14 pharmacy for disposal was recorded. Policies and procedures were in place for staff to refer to and staff who administered medicines had received training. Whilst some medication administration records were typed as provided by the supplying pharmacy some had been handwritten by staff. Deficits were found in some recording aspects of these. There was largely a lack of signatures evident on the prescription boxes that were handwritten, a spelling error was found in the name of a drug and one prescription had no dosage instructions, frequency or maximum limit of the drugs use recorded. Where variable dosages were prescribed the actual dosage administered was not being recorded. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Policies and procedures were in place to ensure any allegations or complaints were handled appropriately and in the best interests of service users. EVIDENCE: The Commission for Social care Inspection had not received any complaints or concerns regarding the service since it opened. At the home 3 complaints were recorded in the homes log. The actions that had been taken were recorded and appeared to satisfactorily investigate and record outcomes that were found. There was poor recording of the date that complaints were resolved. The complaints procedure was included in the information pack given to service users along with cards they could complete and post off if they had any concerns. Service users spoken with said they would feel able to approach staff if they had worries and named the staff the staff they felt they would go to. The information pack given to service users also included information on Safeguarding Adults and what would happen if any allegations were made. A policy and procedure was available relating to Safeguarding Adults which referred to locally agreed Safeguarding Adults procedures. The reporting cards and information on this process was also available in the home. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 16 There have not been any allegations of abuse reported since the home opened. Staff spoken with said they had received training in Safeguarding Adults which was verified by the training records available. They also gave clear information on how they raise concerns and were aware of the whistle blowing policy. The care plans in place included information on service users capacity to handle their own financial affairs and also detailed what help was required where this was assessed as being needed. The service users largely managed their own affairs with some help given by staff to plan and budget how monies were spent. Some monies were stored safely on behalf of service users and records were kept. These were examined which indicated service users were involved in signing for their money along with 2 staff signatures. Receipts for any purchases were retained and monies were stored separately for each service user. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home is well designed and offers comfortable accommodation with a range of facilities available that enable service users to improve their independent living skills. EVIDENCE: The home is a purpose built home which provides accommodation for service users in individual bedrooms with spacious en suite shower rooms. 11 rooms were in the main part of the home with 2 additional beds located in semi detached bungalows in the grounds of the home. These were fully equipment units with a bedroom, bathroom and lounge/kitchen where service users could be supported to experience independent living whilst still receiving any support they needed to build confidence/skills. A range of bedroom styles were available, all of which were well designed. Some bedrooms had additional facilities such as a fridge, toaster and kettle. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 18 Other bedrooms had a separate lounge/kitchenette area with an oven and hob where service users could improve independent living skills with support where required from staff. All service users spoken with were highly complimentary of the environment and the facilities it offered to them. Service users spoken with said they had keys to their room and rooms were personalised. All service users spoken with displayed a motivation to improve skills and were proud of their rooms. The home has a dedicated lounge where service users can smoke. This has an electrical ventilation system and a glass panelled door to enable staff to observe service users. The garden area was found to well tended with a seating area for service users to use. A barbeque had been held in the summer in the garden. The home was furnished to a high standard, tastefully decorated and clean throughout. There was one main lounge available and other communal areas that Gloves were available for staff to use and discreetly locked cupboards were in place to store chemical cleansers. One bathroom was fitted with a hoist which lowered service users into the water. Handrails and a staff call system was fitted throughout the home. The laundry area was fitted with an industrial washer and dryer. Service users spoken to said they did their own laundry assisted by staff if they needed help. One service user spoken said that staff were supportive and they felt able to ask questions without fear of them being regarded as trivial such as how much wash powder do you put in the machine. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are systems in place to ensure staff are recruited, trained and supported to ensure service users needs are met. EVIDENCE: The occupancy of the home on the day of the visit was 5 service users. The typical staffing levels at the home were 2 care staff for day shifts, this is included one senior care. Usually the Manager was available during office hours in the week and a ‘mid shift’ to cover the daytime was frequently used. At nights there was one waking care staff and one sleep in carer. Staff spoken with were knowledgeable regarding service users and positive jovial exchanges between staff and service user were observed. Service users spoken with said the staff were ‘excellent and would sit and talk when you needed to’. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 20 From the Annual Quality Assurance Assessment and discussions with the Acting Manager it was established there were 9 care staff employed at the home of which 3 held NVQ (National Vocational Qualification) level 2 in care qualifications. A sample of three staff personnel files were examined. These confirmed that references and application forms had been completed by staff. Proofs of identity and photographs were also on file. POVA first checks were on file for all staff and some staff had commenced employment prior to the full Criminal records Bureau checks being returned. The Provider has regular training sessions available which includes an induction training that covers First Aid, Safeguarding Adults, Health and Safety and infection control. Additional training had been competed by staff included basic food hygiene, medications, epilepsy, and non-violent interventions for staff. Staffs spoken with were positive regarding the training opportunities they had received. Where staff had recently been confirmed in post there was evidence of training being planned. Moving and handling training was planned for mid October. The recording of training was both on a unit wide matrix and an individual staff basis. Staff appraisals were planned to be on a six monthly basis. An ‘E learning’ tool is in the process of being implemented to enable to staff to participate ongoing learning at their own pace. The tool was stated to provide a skill based learning tool equivalent to the common induction standards. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has made a very positive start towards providing a service where service user are consulted, respected and given opportunities to develop. EVIDENCE: The Acting Manager of the home is a qualified Social Worker who has experience of working with a wide range of service users. An application has been submitted for the Manager to become formally registered with the Commission for Social care Inspection. Staff spoken with were positive regarding the Manager stating that ‘it was nice to have a manager you turn to’. Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 22 Service users meetings are held on weekly basis and minutes were documented. Service users spoken confirmed that meetings were held and they were consulted regarding menu choices and activities. The quality assurance processes in place were examined. Monthly visits made on behalf of the Provider were documented. These included some discussions with service users to establish their views of the service as well as a wide range of other aspects including examination of records and Health and Safety checks. Accidents were recorded on appropriate forms and staff had recorded what actions, if any, had been taken. These were stored within service users files where they related to service users. Water outlets were fitted with thermostatic controls and regular checks completed to ensure these were fully functioning. A sample of service certificates was checked for the appliances and fixtures in the home. These indicted that all required serving and checks were in date. Moorfields DS0000069511.V340905.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 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 Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 2 x 3 x 3 x x 3 x Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? This is the first inspection since registration 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 YA20 Regulation 13(2) Requirement Where variable dosages of a medication are prescribed the actual dosage administered to the service user must be recorded Medication administration records prescriptions must include all required information to ensure a drug can safely and accurately be administered to the service user Timescale for action 15/10/07 2 YA20 13(2) 15/10/07 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 YA20 Good Practice Recommendations Where medication administration records are handwritten they should be signed by the completing staff member and checked and verified by a second staff member to ensure accuracy Complaints records should clearly include the dates that complaints were resolved and how the complainants were informed of the outcome of the investigations DS0000069511.V340905.R01.S.doc Version 5.2 Page 25 2 YA22 Moorfields Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Moorfields DS0000069511.V340905.R01.S.doc Version 5.2 Page 26 - 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!