Inspection on 12/12/06 for Neville Grange Resource Centre

This inspection was carried out on 12th December 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Neville Grange Resource Centre 23/11/05

Neville Grange Resource Centre 07/06/05

Neville Grange Resource Centre 07/12/04

Neville Grange Resource Centre 15/07/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Neville Grange Resource Centre Queens Road Saltaire Shipley BD18 4SJ Lead Inspector Karen Westhead Key Unannounced Inspection 12th December 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Neville Grange Resource Centre Address Queens Road Saltaire Shipley BD18 4SJ 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) 01274 593399 City of Bradford Metropolitan District Council Department of Social Services Mr Roy Wilks Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (2) of places Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd November 2005 Brief Description of the Service: Neville Grange is owned and run by the local authority. The home looks after older people who need care for long or short periods of time. There are also rooms for people who book regular respite periods of stay or those who need to be looked after following hospital treatment (intermediate care) and who intend to move back home. Linked to the home is a day centre. This is run independently from the care home. However some of the residents do use the facilities. Neville Grange is registered provide care for up to 35 older people. It is in the village of Saltaire, also known as a world heritage site. There are a lot of shops nearby. There is also a post office, a number of churches, restaurants and pubs. The home is near to a main bus route. There is limited parking in the grounds of the home, otherwise on street parking is available. Information about the home is provided in a statement of purpose and service user guide. Both these documents were reviewed and updated in September 2005. The current fees charged are from £94.43 and £435.65 per week. There are additional charges for hairdressing; newspapers and chiropody. This information was provided by the home during this visit. Fees are reviewed in April every year. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was done by one inspector and had not been prearranged with the Manager. The inspector arrived at 9.00am and left late teatime. At the end of the visit, the assistant manager was told how well the home was being run and what needed to be done to make sure the home meets the required standards. The reason for the visit was to make sure the home was being run for the benefit and well being of the residents and in line with requirements. The home had had another inspection on 23rd November 2005. Also, during the visit the quality of information given to people about the care was looked at. Residents were asked about the information to see if they could understand it and how it had helped them make a choice about moving in. The service user guide; (or brochure) the contract of care and the complaints procedure were looked at. The findings from this part of the visit are going to be used as part of a wider study being carried out by the CSCI to assess the information being given to people about care homes. A report is to be published in May 2007. For those wanting further information, please see our website www.csci.org.uk. Before the inspection information received about the home was reviewed. This included looking at the number of reported incidents and accidents, the action plan provided following the last inspection and reports from other agencies such as the fire safety officer’s report. This information was used to plan the inspection visit. A number of records were looked at during the visit; all areas of the home were seen. The inspector also talked to residents, the manager and staff. The fourteen CSCI comment cards received after the last inspection report have been analysed. Residents and relative’s views are included in this report. Generally, residents and their relatives said they were satisfied with the care provided. However, seven cards said the home was short staffed, one card said a respite resident needed more help with their medication when coming to stay, one card said more activities should be provided during the afternoon. All other responses said the service was good sometimes, usually or always. What the service does well: The atmosphere at the home is welcoming and homely. The manager provides clear leadership and there is a stable and close-knit staff group meaning there is stability and consistency for the residents. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 6 The relatives of one recently admitted resident had been well supported. They said they had been allowed to visit the home before their relative moved in and this had given them the opportunity to meet staff and ask questions. One resident said the home had made it possible for her to come and stay with her cherished pet, a parrot. There is a commitment to staff training and the staff are knowledgeable about the needs of the residents. There is a system in place for regular feedback from residents about the home as well as other healthcare professionals who visit the home. There is good communication with the residents and their families. Relatives are made very welcome. Residents talked about the care and attention staff provided. Some comments included: • ‘the care and support is always good at Neville Grange’; • ‘the staff are always available when I need something doing’; • ‘I need a footstool when I come to stay and it is always in my room when I arrive’; • ‘staff are cheerful, helpful and welcoming’; • ‘my room is always clean and is warm and cosy’; • ‘my gran is very happy here’. What has improved since the last inspection? What they could do better: There must be a continual review of the staffing arrangements in the home to make sure there are enough staff to carry out the caring and domestic duties in the home. There must also be sufficient staff on duty to make sure the Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 7 wishes and choices of residents are not compromised, for example the times they wish to get up or go to bed. Care plans must include information relating to each resident’s specific needs, to make sure staff know exactly what needs to be done to met them. It is recommended that a shower is fitted for residents. 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. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre admission assessment process is good. Residents are given written information about the home, which helps them decide whether Neville Grange will suit them. Residents’ benefit from a well organised service. EVIDENCE: There is a statement of purpose and service user guide available to residents and their families. An additional leaflet is given to those not moving in on a permanent basis. Residents and their families said they felt that they had been provided with enough information to help them make an informed decision to move into the home. All those who returned comment cards said that they had been given a contract. Copies of contracts were seen in individual care records. All residents have their needs assessed before they are admitted to the home. Trial visits are also encouraged if at all possible. The pre admission Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 10 assessments seen for a sample of residents were good. The information set out the reason the resident was coming into the home, a brief history and what staff needed to do to meet their needs. Once a resident has been admitted to the home a further more detailed assessment of their needs is carried out. The unit providing intermediate care is well organised and staff work with a range of other professionals to make sure residents admitted for rehabilitation before returning home or a placement other than residential care keep as independent as possible. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff show a good awareness of residents’ needs and there is good communication amongst them. Care records do not always provide evidence that residents’ needs are met. Residents are treated with dignity and their privacy is maintained at all times. EVIDENCE: Care plans are in place for all residents and a random selection were looked at in detail. Overall care plans contained adequate information for staff and there was evidence that residents were involved wherever possible. The format is standardised. Staff need to make sure that these records show specific details of individual needs. For example, one resident had been shown to be at risk from not having enough to eat. But had not been weighed for several weeks and their dietary intake was not being monitored by staff or ways to encourage the resident to eat more. Information should be provided to staff about exactly what steps are to be taken and why. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 12 Records are reviewed monthly. To make sure staff are keeping up to date of any changes in care needs and so that that this can be recorded. Staff are knowledgeable about the care needs of the residents and residents have confidence that they will be well looked after, saying ‘staff know what I like’. Other healthcare professionals are involved in the home. The staff are clear about when to seek advice if they feel the home can no longer meet specific needs of residents. This can be either due to mental health problems or because they need more nursing care input than can be provided by the district nursing service. Observation and discussion showed that staff respect the privacy and dignity of residents. For example, when the bathrooms are being used a sign is hung on the door as well as the lock being used. Also when staff were helping residents to maintain their personal hygiene this was offered in a discrete manner and resident are taken to their own rooms to be attended to. Staff involved in the administration of medicines are receiving additional training. Mistakes were picked up during an audit of the records by senior managers and as a result of this a new procedure has been introduced to make sure residents are receiving the correct medication at the correct times. Residents wishing to take control of their own medication are taken through a risk assessment first. Several of the residents spoken to during the visit take care of their own tablets. There are suitable facilities for them to keep them safely and staff provide support according to the circumstances and level of guidance needed. One comment card raised the view that a respite resident needed more help with their medication when coming to stay. The identity of the person making this point was not provided, however, it is important that their view is noted so that staff are in a position to check this out with all residents to stay. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ choices are respected and contact with family and friends is encouraged. A good and varied diet is provided. EVIDENCE: Care plans included what residents liked to do with their leisure time. Information received from one comment card said that some residents did not always feel that there were enough activities in the afternoon. The home employs an activity organiser who looks at ways of involving residents in both large and small group activities. The home has an adjoining day centre. Residents do not automatically have access to this facility. However, arrangements are in place for residents to attend organised events if appropriate. Some residents continue their attendance if they are staying at the home for respite or intermediate care. Trips out are organised, monthly entertainers and in-house bingo and quizzes are examples of activities and stimulation provided. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 14 Residents said that relatives are welcome at the home and are able to visit at any time. Those visitors spoken to repeated this view. Residents spoken to said they were happy with the arrangements about going to bed and getting up. Those residents who are able to self-care said they were left to make their own decisions about this. Those needing assistance do seem to have some choice. One comment card said that one resident had to wait to be got up in a morning if there weren’t enough staff on duty. Residents spoke in positive terms about the food provided at all mealtimes. The cook takes a pride in her work and makes sure the menus reflect the preferences of residents. The main meal was sampled during the inspection. It was hot, tasty and well presented. Residents were seen enjoying their meal. Staff eat with residents in each of the four dining rooms. Residents are given their post unopened therefore respecting their privacy. Staff know which residents need help and were seen to offer an appropriate level of assistance. There were plenty of newspapers and magazines around for residents to read and keep up to date on current affairs. One resident, who stays at the home one week out of six, gave a frank account of her experience at Neville Grange. She said the staff had gone a long way to make sure her visits were planned properly and that she had everything she needed to make her feel at home. Including bringing her cherished pet, a parrot, with her. She was very clear about what her stay involved and she said she wouldn’t stay if it wasn’t ‘just right’. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously. Residents feel safe living at the home and are protected from abuse. EVIDENCE: Residents were asked what they would do if they were unhappy. They said they would speak to a member of staff or their relative. The home has appropriate policies and procedures in place to deal with complaints and adult protection. Two complaints had been dealt with by the home since the last inspection. These had been investigated properly by the home and action taken where necessary. No other complaints had been received. The manager tries to deal with complaints before they get out of hand and works hard to promote an ‘open door’ policy. This lets residents, staff and relatives bring matters to his attention in order for them to be acted upon. A record is kept of all complaints received and the action taken. Residents, relatives and friends are able to access the complaints procedure easily. All of the people spoken to during the inspection said that they are able Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 16 to speak to the manager or staff if they have any concerns or worries. Staff have received training in adult protection and there is a whistle blowing procedure in place. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Neville Grange is well presented and residents are comfortable living there. It is recommended that a shower be provided for residents. EVIDENCE: All areas of the home used by residents were visited during the inspection. Bedrooms and communal areas have good quality furniture, which is suitable for its use. Rooms have equipment, which helps people to keep their independence. There are no en suite facilities, so all residents use communal bathrooms and toilets. Three residents said they would prefer a shower rather than the baths Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 18 currently provided. This is of particular importance for those who stay in the home for short periods and are used to a shower at home. The quality of bed linen seen was good. The industrial kitchen is well equipped. The cook said all the equipment was working. Some residents have tea and coffee making facilities in their rooms. During the visit there was a problem with the passenger lift. A resident and a family member got stuck when the lift doors would not open on the ground floor. Staff dealt with the incident calmly and an engineer was called immediately. Since the last inspection an additional room has been provided for residents who chose to smoke, leaving a smoke free lounge available for other residents. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are trained and competent to meet the needs of the residents. There are good recruitment procedures in place to protect the residents. But staffing levels need to be closely monitored to make sure there are enough staff at all times. EVIDENCE: The manager and staff are a stable team who are supportive of each other. This means there is continuity and stability for the residents. The Assistant Manager discussed how staff are recruited. There are adequate safeguards in place to make sure staff are suitable. However, the staff files seen included a written reference, which had not been signed. The Assistant Manager confirmed this may have been an oversight and agreed to deal with it. The staffing levels at present mean that there are not enough staff to cover the care duties. Domestic staff who are properly trained are used to cover the shortfall in hours, which means there is a shortage of domestic staff available. At these times general cleaning is done with more through cleaning being left. However, there was no evidence of the home not being clean and there were Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 20 no unpleasant odours. Staff said they worked as a team to make sure the home was kept running and that they helped each other. The Assistant Manager said staff were flexible and had a lot of goodwill to offer. Seven of the comment cards received by CSCI did mention that there was a shortage of staff at times. This had resulted in one person not being able to get up at their chosen time and had caused some concern for others. The registered person must make sure that staffing levels are continually reviewed, including night duty. Training is seen as important and staff have access to relevant courses. Those spoken to felt they were given plenty of training opportunities. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed; the interests of the residents are important to the manager and staff and they are safeguarded at all times. EVIDENCE: The manager has many years experience working with older people and has the necessary qualification to carry out his job properly. Staff and residents spoken to all feel he offers them good support and is ready to listen to ideas they may have. Staff said there were clear management structures in place and they were given proper leadership and guidance. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 22 Christmas arrangements were well underway at the time of this visit. The responsible person carries out monthly visits to the home as required. Reports are made available to the CSCI. These visits are to make sure the home is being run properly and are called Regulation 26 visits. The manager has actively sought the views of residents and their families about the care provided at Neville Grange. The findings are yet to be published but there was a good level of satisfaction expressed. Bradford Social Services is responsible for keeping some residents personal monies if they are not able to do this for themselves or do not have a relative to do it. There has been an agreement with CSCI about how this money is administrated and the home is following these guidelines. The records seen make it possible for all transactions to be audited and the senior staff have to reconcile all the monies used and provide written proof. This makes sure residents affairs are kept in order and they are safeguarded. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 15 and 17(1)(a) Schedule 3 18 Requirement The registered person must make sure that care plans include all the information needed by staff to make sure residents needs are met in full. The registered person must make sure there are enough staff on duty at all times to meet the needs of residents. Timescale for action 06/02/07 2. OP27 06/02/07 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 OP21 Good Practice Recommendations The registered person should consider providing a shower for residents. Neville Grange Resource Centre DS0000033532.V321104.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Neville Grange Resource Centre DS0000033532.V321104.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. 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