Inspection on 14/04/05 for Mount Pleasant

This inspection was carried out on 14th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mount Pleasant 23/07/09

Mount Pleasant 16/05/07

Mount Pleasant 28/07/06

Mount Pleasant 31/10/05

Mount Pleasant 10/11/04

Mount Pleasant 11/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Mount Pleasant Finger Post Lane Norley Via Warrington WA6 8LE Lead Inspector Sue Dolley Unannounced 14 April 2005 09:45 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 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. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Mount Pleasant Address Finger Post Lane Norley Via Warrington Cheshire WA6 8LE 01928 787189 01928 787189 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) Pribreak Limited Acting manager Tina Padden Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Mount Pleasant is registered to provide care for twenty five residents falling within the category (OP) old age Date of last inspection 10/11/04 Brief Description of the Service: Mount Pleasant is a converted, extended care home registered to provide caare and accomodation for twenty-five residents. It is in the village of Norley on the road from Frodsham to Cuddington. The home is set in large grounds, has attractive views across farmland, and provides a tranquill setting with adequate car parking facilities. Residents are accomodated on two floors. Access between floors is via a stair lift or stairway. There are 21 single rooms and two shared bathrooms, all of which have wash hand basins. Communal space consists of two lounges, a large room and a small sitting area in the entrance hall. Mount Pleasant provides a well cared for, bright and welcoming environment. Throughout the building there are an adequate number of toilets and a variety of bathrooms available for residents. There are aids around the home to help residents and these include bath hoists, grab rails and an emergency call bell system. There is a large, attractive garden with a number of sitting areas and pathways available for service users. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 14th April 2005 over a period of 8 hours to assess if the service was meeting the needs of people who use it and to check the response to the requirements and recommendations made at earlier inspections. A partial tour of the premises took place and included all lounges, sitting areas and dining rooms, shared bathrooms and toilets and the laundry. Several members of management staff on duty, 4 residents and 1 visitor were spoken to during the inspection and a selection of resident and home records were inspected. Comment cards were provided for the home to circulate to residents, relatives and visitors to get their views and comments about the standard of care provided. What the service does well: What has improved since the last inspection? Appropriate training is now being pursued for management and care staff, and formal supervision is being arranged. Weight monitoring charts are currently being introduced to record the weight of residents when there are concerns regarding nutrition and fluctuating weights. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 The process of moving people into the home is well managed to make sure residents individual needs can be met and to help them quickly settle into their new environment. EVIDENCE: All residents have their needs assessed before they move into the home. The staff of the home gather information from the prospective residents, their relatives, and social services and health care representatives to ensure assessed needs can be met. The information is used to draw up care plans. 3 care files of residents recently admitted were checked. They provided full information and the reason for each admission was clearly stated. Pre assessment documentation is compiled by social services, hospital staff and staff at the home. Some social history information has been provided by the relatives of residents, and some social history is awaiting completion by staff. 3 new residents spoken with during the inspection said that they had received a warm welcome from staff members and had developed friendships. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 9 They said they were very pleased with the standard of care provided and with their new environment. Mount Pleasant does not provide intermediate care. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8.9.10, and 11 Residents are looked after well in respect of their health and personal care needs. However, their care plans do not always state exactly how all of their identified care needs will be met. Further work needs to be done so that all staff know at all times what they should be doing to meet the residents’ needs. Recording of administration of medication needs to be improved so that it can be established that every resident is receiving their medication as prescribed. EVIDENCE: Of three care files checked, one was completed in full and was explicit. One itemised the care needs but did not indicate how each specific need would be met and the date of the assessment was not recorded. One care plan was incomplete and the care sections on personal care and physical well being, communication, and mobility and dexterity had not been completed either at the time the person moved in or at a later review. In each of the files checked, the reason for the person moving into the home was clearly stated. The care plans are basic and in some cases, the elements of care recorded do not reflect the high quality of care residents said they receive. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 11 The residents spoken with confirmed that they felt that they were treated with respect and that their right to privacy is upheld. Staff members receive training during their induction on residents’ rights to privacy, dignity and respect. They are reminded of these during supervision and their day-to-day work. Several residents praised the staff team for the quality of care provided. Staff members were observed to work together as a team to anticipate needs and to provide prompt care and attention. The care plans checked showed that residents have access to wide range of professional help to meet their health care needs. Appropriate referrals had been made. All contact with health care professionals had been satisfactorily recorded with detailed information about the outcome of each visit. Currently records are being maintained to check weight gain or loss and to aid nutritional screening and care. Residents are able to register with a GP of their choice as far as possible. Residents’ health and wellbeing is carefully monitored. The home uses a monitored dosage system for medication administration. Staff members have received training on how to use this from the pharmacist who supplies the medications. Although the controlled drug records were well maintained, other medication administration records contained errors which would make it difficult to establish whether residents had received their medicines as prescribed. There is a procedures manual in the home about care of the dying and bereavement. Most, but not all, of the residents had made been asked about their wishes so that staff and relatives would know what to do in the event of a death. The information was recorded in their care files. (See Requirement 1 and Recommendations 2 and 3) Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14, and15 Residents are able to make choices about their daily lives including taking part in a wide range of activities, so they can keep as active as they wish to be. They described the choice and quality of the food as very good. Alternative meals and special diets are available so that all service users have a varied and nutritious diet of food that they enjoy. EVIDENCE: Residents confirmed that they could choose to take part in activities as they wished. Details of the activities available are displayed on notice boards in the home. The range of options included pub lunches, reminiscence sessions, bingo, videos, fitness sessions, karaoke and sing-alongs, parties to celebrate special events, use of a library, and church activities. Residents can bring personal items with them when they move into the home, including furniture items. They have used these to personalise their rooms. They said that they could choose the time they got up, when they went to bed, and where they spent their time during the day. Visitors to the home are warmly welcomed and residents are able to have visitors at any reasonable time, in the privacy of their own rooms if they wish. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 13 The pleasant dining room is a favourite place for some service users to sit together to chat before and after meals. Residents were very complimentary about the standard and choice of food provided. The cook discusses meal choices every day with each resident and alternatives are provided. The sample of menus seen showed a range of nutritious, traditional meal choices. Relatives are welcome to dine with residents by request. One visitor spoke of being invited to have Christmas lunch at the home so he could join his wife and another family member for a meal. He described the management of the home as thoughtful and caring to ensure everyone is involved whenever special events are planned. Residents are able to handle their own financial affairs and medication for as long as they wish to and have the capacity to do so. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints procedure does not include information that complaints will be responded to within a maximum of 28 days and so complainants may not feel confident that their complaints will be acted upon promptly. Staff members need to develop their awareness about the protection of vulnerable adults to ensure they know how to safeguard residents. EVIDENCE: No complaints have been made to the home or received by the Commission for Social Care Inspection since the last inspection of the home. The home has a written complaints procedure which provides contact details of The Commission For Social Care Inspection but does not include reassurance that complaints will be responded to within a maximum of twenty-eight days. The interagency policy and guidance on adult protection procedures is available but staff members are not familiar with them. Documentation is missing and staff members have not yet received training on protection of vulnerable adults. The home does not have its own policy to guide staff about reporting poor practice and allegations of abuse but there is a copy of the National Care Home’s Association’s sample whistle blowing policy in the home. See Requirement 2 and Recommendations 3,4, and 5. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,22 and 26 The home is very well maintained. It is decorated and furnished to a good standard and this helps to create a comfortable and homely environment for residents. EVIDENCE: The communal areas, lounges and dining room, bathrooms and toilets and laundry were checked and were all well presented and clean. There is a routine programme for maintenance; redecoration and renewal to ensure all areas in the home are kept clean, cared for and comfortable. Since the last inspection a risk assessment has been undertaken on radiators in the home and a radiator cover has been fitted within a downstairs toilet area. The acting manager confirmed that as rooms are refurbished, further radiator covers are to be fitted throughout the home as necessary. One bathroom contained numerous items of equipment so that residents could not use it easily. Additional storage for aids and equipment is necessary. See Recommendation 6 Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 16 The home was clean, hygienic and free from offensive odours. Several residents confirmed that the home is always clean and fresh throughout. The laundry is small but adequate to deal with the volume of laundry generated within the home. There is guidance for staff about infection control and disposal of waste. However, the risk of infection could be minimised by the following: • • Using only the liquid soap already provided in shared bathrooms and toilets and removing the bars of soap Removing linen hand towels from shared bathrooms and toilets and using paper towels instead with suitable waste bins being provided. See Recommendation 7. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 Staff members are employed in sufficient numbers to meet the needs of residents. They are well trained and keen to undertake further training so they can provide the best possible care for residents. The home takes steps to protect residents by thoroughly checking all staff who are employed there. EVIDENCE: There is a stable and loyal staff team and, apart from the recruitment of an acting deputy manager, no new staff have been appointed since the last inspection. The recruitment procedures followed have been thorough to ensure the protection of residents. The staffing rotas showed there were enough care, management and ancillary staff on duty to meet resident’s needs, including at peak times of the day. The staffing hours, total 531.50 hours per week. There is a least one senior member of staff and two care assistants on duty during the daytime. At nighttime 2 waking night care staff are on duty, 1 or both of which are senior staff members. The staff team was seen to work well together for the benefit of service users. There is an active training programme in which most members of staff take part. Care staff are undertaking or have completed NVQ Levels 1 and 2 training; other appropriate training for care staff and management staff is due to start or has recently been completed. The acting manager and acting deputy manager are due to start the Registered Managers Award training. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,36 and 38 The proprietors and managers are approachable and residents and their relatives provide feedback to them about the service provided. Some improvements to financial procedures are necessary to ensure that residents’ personal allowances are accurate. Some safe working practices must be adopted to ensure that the safety of residents and staff is promoted and protected. EVIDENCE: A comments record has recently been introduced to obtain written feedback from residents, relatives and visitors to the home. There has been an intention for some time to provide residents and families with questionnaires to establish their views regarding the standard of care provided and an intention to circulate these questionnaires at regular intervals. See Recommendation 8. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 19 Residents or their relatives manage residents’ finances. However, the home’s staff members help manage some residents’ personal allowances. Although most of those checked were found to be accurate, two were incorrect in that they contained small excesses of money. See Recommendation 9. Staff members are supervised daily as part of the normal management process. The management team are planning a schedule of supervision and will develop a form for recording formal supervision sessions. Regular staff meetings may also be reintroduced. See Recommendation 10. From training records it was evident that staff training is arranged regarding safe moving and handling, food hygiene, and health and safety. A current certificate of public liability insurance cover was on display within the home. The fire precautions record book showed that the fire alarms and emergency lighting were tested regularly and that fire safety equipment was serviced. The recommendations made at a recent fire inspection had also been satisfactorily implemented. To improve safety it is advised that a heat detector/smoke detector be fitted within a downstairs linen store cupboard. Fire safety records indicated that fire drill evacuations had been undertaken annually but these should now be undertaken twice yearly as a minimum. Fire training records indicated that fire training for staff was last provided in October 2004 and refresher training must now be provided. See Requirement 3. Accurate accident records were kept but it was difficult to establish the number and type of accidents that had occurred over a period of time. It is suggested that copies of all accident records are also kept together for audit purposes. Some wheelchairs being used for residents did not have footrests which creates a risk of injury to service users. See Requirement 4. Minutes of a staff meeting included a statement, which advised staff members to ‘bleach’ cups and saucers regularly. Advice was given to management to ensure bleach is not used in future and other safer means of sterilisation are used instead. Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 2 x 2 2 x 2 Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 21 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 9 Regulation 13 Requirement All care staff must ensure that that medication is administered as prescribed, that accurate medication records are kept and that they receive refresher training regarding the recording, handling, safekeeping, sfe administration and disposal of medicines received into the care home. All staff must receive training on the protection of vulnerable adults. (This requirement remains unmet from the last inspection on 10.11.2004. The previous timescale of 31.03.05 has elapsed and anew timescale of 31.05.05 has been set). There must be adequate arrangements for detecting fires, and for the evacuation of all persons in the care home. Fire drills and practices must be carried out at least twice a year. All staff must receive suitable training in fire safety and prevention. Timescale for action 31.07.05 2. 18 18 31.05.05 3. 38 23 31.05.05 Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 22 4. 38 23 and 13 All wheelchairs should be 31.05.05 checked and missing footrests must be replaced. Footrests must be used when service users are being moved in the wheelchairs. 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 7 Good Practice Recommendations A plan of care for every resident should be produced from the assessment, shortly after the resident moves into the home. The care plan should include explicit information on how each care need will be met. (A similar recommendation was made at the previous inspection on 10.11.04) Residents wishes concerning terminal care and arrangements after death should be discussed, recorded and carried out. (This recommendation has been partially actioned from previous inspections on 11.05.04 and 10.11.04). The complaints procedure should include information that complaints will be responded to within a maximum of twenty-eight days. Refresher training for staff on No Secrets should be provided. A sample adult protection trigger form from social services should be obtained for staff to refer to. A whistle blowing policy and procedure for use in the home should be produced. Additional storage space for aids and equipment, including wheelchairs, should be provided. The bars of soap and linen hand towels should be removed from the shared bathrooms and toilets. Paper towels and waste paper bins should be provided. An internal quality assurance audit should be undertaken at least annually and feedback sought from service via questionnaires. The results should be published and the results used to inform future planning. Regular checks of residents personal allowances and records should be undertaken to ensure that these are accurate. Numbered receipts should be kept to correspond with the entries on the records. F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 23 2. 11 3. 4. 5. 6. 7. 8. 18 18 18 22 26 33 9. 35 Mount Pleasant 10. 36 Staff should receive formal supervision at least six times a year and supervision should cover all aspects of working in the home and career development needs.(This recommendation was made at the inspection on 10.11.04). Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Mount Pleasant F51-F01 S6622 Mount Pleasant V220922 140405 Stage 4.doc Version 1.20 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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