Inspection on 16/05/05 for Obelisk House

This inspection was carried out on 16th May 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 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

Obelisk House 12/09/06

Obelisk House 14/11/05

Obelisk House 09/12/04

Obelisk House 16/08/04

Obelisk House 11/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE OBELISK HOUSE Obelisk Rise Kingsthorpe Northampton NN2 8SA Lead Inspector Pat Harte Unannounced 16th May 2005 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. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Obelisk House Address Obelisk Rise Kingsthorpe Northampton NN2 8SA 01604 850910 01604 850912 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) Mr Philip Jones, NCC Oxford House, West Villa Road. Wellingborough, Northants, NN8 4JR Mrs Frances White CRH 44 Category(ies) of OP Old Age - 44 places registration, with number DE(E) DEmentia - over 65yrs - 12 places of places PD(E) Physical Disability - over 65yrs - 8 places OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: To be able to retain the existing named service user within the category of sensory impairment over the age of 65 years SI(E). No person falling within the OP category can be admitted where there are already 44 people of OP category already in the home. No person falling within the DE(E) category can be admitted where there are already 12 people of DE(E) category already in the home. No person falling within the PD(E) category can be admitted where there are already 8 people of PD(E) category already in the home. To be able to accommodate three named service users who have needs within the MD(E) category. To be able to accommodate one named service user who has needs within the SI(E) category. Total number of service users in the home must not exceed 44. Date of last inspection 9th December 2005 Brief Description of the Service: Obelisk House is a residential care home providing personal care for up to 44 Elderly Residents, including 12 people with Dementia and 8 people with Physical Disabilities. The Home has additional conditions to be able to continue providing care for 4 Residents who also have Mental Health or Sensory Impairment needs. The Home is owned by Northamptonshire County Council.The Manager is Mrs. F. White. The Home is situated in a residential suburb of north Northampton and comprises of all ground floor accomodation. The pemises offer 4 self contained units with their own lounge dining rooms and bathing and toilet facilities. Single bedrooms are provided for all Residents. There is also a central lounge area at the entrance. The Home provides pemanent care only. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for Service Users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting 3 Residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. 5 staff and 11 Residents were spoken with and written comments were also received from 32 Residents. Whilst comments were generally positive there were some negative comments on the activity programme and the availability of staff. 21 Relatives provided written comments again mostly positive but 6 felt there were insufficient staffing levels. 3 positive comments were received from visiting Medical Practitioners. A partial tour of the premises took place and a selection of records was inspected. The Inspection took place during the late morning and afternoon over a period of 5 hours and was carried out on an unannounced basis What the service does well: The Home has a committed staff group. Residents spoken with felt that their relationships with staff were very good and that staff provided them with care and support. Residents who are unable to visit the Home prior to their admission are provided with written information on the service to help them decide on the placement. Residents felt that they were valued as individuals and their wishes and preferences were respected. Routines were flexible and Residents were supported to be as independent as possible. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 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 OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 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) 1, 2, 3, 4 & 5 Prospective Residents are provided with information about the Home to enable them to make informed choice regarding their placement. The pre-admission assessment is effective in ensuring that the physical of Residents can be met though further development is needed to ensure Dementia care needs are fully identified and that each Resident is provided with a Contract. EVIDENCE: All prospective Residents are visited and assessed by staff from the Home. Residents and their relatives have opportunities to visit the Home prior to admission and are given written information on the services and facilities. Residents spoken with felt that staff were briefed on their overall need and the care to be provided. Staff spoken with felt that they were provided with information on Residents needs, routines and wishes at the point of admission. Individual records are kept for each of the Residents and inspection of the records showed that the pre-assessment documentation on physical needs was thorough and included the use of recognised risk assessment tools. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 9 The assessment of Dementia care needs was limited and should be more detailed to assist understanding of behaviours, to identify and address risk areas. Limited information was gathered on life histories but this information was not cross referenced to the care plans and used to develop strategies for care or the management of behaviours. Of the three Residents files viewed one did not contain a Contract or Residents agreement. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 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 & 11 Some progress has been made in developing the care plans but the plans do not provide detailed instructions for staff on how the care is to be carried through; plans for Residents with Dementia do not contain detailed guidance for staff on strategies for managing behaviours. EVIDENCE: Individual plans of care are available for all Residents. References to personal care needs had improved but the Plans did not provide a good level of guidance and instruction for staff on how the care was to be carried through. The plans showed that account had been taken of Residents wishes, that preferred routines were respected and that Residents were encouraged to be as independent as possible. The approach to Dementia care is still fragmented, as the Home does not have specialised Dementia care units with trained staff concentrated in specific areas to meet needs. Whilst risks from behaviours are identified there were times when areas of the Home were left unsupervised and Residents were not monitored or supervised. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 11 Guidance for staff on how they support Residents with Dementia needs is being developed but further work is needed to fully detail strategies for the management of risks and behaviours. The administration of medication was not safe as the staff member carrying out the midday medication round left the medication cabinet unlocked with a box of medication left unattended in the kitchen of the unit and was potentially accessible to Residents. Service Users felt that they were treated as individuals and were respected by staff. Staff ensured that their privacy and dignity was protected when personal care tasks were carried out. Staff were sensitive to the needs of Residents with Dementia and took time to talk with then and deal with their anxieties. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 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 & 15 The activity programme is limited and does not provide suitable and meaningful activities for Residents with Dementia. The arrangements for the serving of meals were not efficient. EVIDENCE: A number of Residents were spoken to and everyone who commented on the food said they had choice and their special and likes and dislikes were catered for and respected. The serving of the midday meal was not efficient. In one dining room the main choices were plated and served to all the Residents, the tureens of vegetables were then taken out. The management of the serving arrangements meant that the main choice had cooled considerably before the residents received their vegetables. In another lounge the containers were withdrawn from the hot trolley and meals individually plated and taken out. By the time the staff served up the last meal the food in the containers was sampled and found to be going cold. Residents felt routines were relaxed and flexible and that their preferences on rising and going to bed times were respected. They felt that they were free to decide on how and where they wished to spend their time. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 13 Whilst an activities programme is provided no activities were taking place during the Inspection. Residents are kept informed of events, activities and general news by the regular production of the Home’s Newsletter. The programme is mainly limited to group activities and Residents commented that staff had little time to provide for individual interests or just sit and talk with them. The activity programme for people with Dementia is under development to include meaningful individual activities. Currently Life History information is gathered but little progress has been made to use this information to develop individual activities. The Home has an open visiting policy. Residents confirmed that their Visitors were made welcome and that they were enabled to see them in private if they wished. Staff recognised the importance of good communication with Relatives keep them informed of their Residents progress. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 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, 17 & 18 Systems are in place to protect Residents from abuse and to ensure that complaints are listened to and acted upon. Resident’s rights are protected. EVIDENCE: Residents confirmed that they had been given the Home’s complaints procedure which is also displayed in the Home. Residents spoken with felt confident and able to raise any issues or concerns with staff. A complaints record is maintained showing that each complaint is taken seriously, investigated and action taken to resolve the issues. No complaints have been received by the CSCI in the last year. The Home has a procedure for the Protection of Vulnerable Adults. Staff spoken with had received training on Elder Abuse and showed that they would react quickly and appropriately to any allegations. Senior staff have responsibility for the reporting procedures to the Authorities. Residents are supported to exercise their civic rights and postal votes are obtained. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 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 - 26 Repairs and redecoration work have not been carried through, where needed, in a timely manner and the garden areas are not safe. EVIDENCE: Considerable refurbishment work has taken place to update and replace tired furniture. Work has been carried out to fence in garden areas making them secure for Residents with Dementia to use. However the gardens present dangers and hazards for Residents as the paving to the central patio area is uneven and drainage gullies run through the centre creating trip hazards. One Resident commentated that she does not use the garden or patio areas, as “they are not safe”. Ramp exits from some Lounges and fire escape doors are hazardous. At least two ramps to the patio area were found to be very steep, no handrails were provided; alterations have been made to other ramps. Ramps from fire exist OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 16 doors lead directly onto grass areas with no pathways, some ramps have a drop of two or three inches onto the grass. Staff expressed concern that it would be very difficult to push wheelchair users away from the building should this be required in an emergency. There are no pathways around the Home. The wall by the main entrance to the building is in a collapsed state. Repairs have been requested but timescales for the work to be carried out have not been determined. The décor of the corridor areas are in need of urgent attention as wallpaper is torn and missing. The Home has suffered from water damage. Although the roof has been repaired staining on ceilings in two Units has not received attention and is apparent in several areas. The ceiling on the bathroom containing the Apollo bath has a hole in it directly over the bath caused by the water damage. Storage space is restricted and the storage of hoists in front of the fire panel in the entrance hall means that staff had to move the equipment to access the panel to turn fire alarms off. There is a potential risk that Residents could access the electrical charging systems for the hoists or trip on the hoists themselves. Staff commented on the difficulty of maintaining an efficient laundry service as the Home has only one tumble dryer, which is insufficient to meet laundry requirements. The layout of the Laundry room was not effective and manoeuvring was difficult for staff. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 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 & 30 Procedures for the recruitment of staff were robust and provided safeguards to offer protection to people living in the Home, however the deployment and number of staff was insufficient to provide monitoring and supervision for Residents with Dementia needs. EVIDENCE: Residents spoken with said that the staff were very kind, committed and caring. However they felt that the Home was short staffed at times and that there were delays in meeting their needs. Staff rotas showed that 6 care staff are on duty on the morning shift with the level dropping to 4 from 2pm to 6 pm and then 5 staff 6.00pm until 10.00pm. 3 care staff provide night cover. As the Home does not have dedicated Dementia care units and there are five lounge areas these cannot be appropriately supervised and monitored during the afternoon shifts. When Residents require the assistance of two staff for movement and handling and personal care tasks this only leaves 2 care staff in the afternoons to monitor the floor of the Home. The sample of two staff members records inspected showed that the necessary checks and references had been obtained. A sample of staff training records inspected did not include inductions records as staff currently retain these. Staff training records detailed core, ongoing OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 18 training and regular updates. Training on specialist areas is provided but there are still some limitations on Dementia care training. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 19 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) 31, 32, 33, 35, 36, 37 & 38. The system for safekeeping of Residents Personal Allowances and moneys was not maintained in their best interests. Fire Alarm Testing was insufficient. EVIDENCE: Staff spoken with felt that the Manager was easily accessible to them and was willing to discuss any issues and guide them in practice. Supervisions systems were in place to ensure that staff receive guidance and support. Residents felt the Manager was readily available to them. They commented that regular Residents meetings were held and that the Manager also sought their individual views. Surveys of Residents and relative’s opinions have also been undertaken. Residents felt that they had trust and confidence in the staff group as a whole. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 20 The systems for the safekeeping of Residents moneys and valuables were inspected. Items held for safekeeping were securely held and carefully recorded. The Home’s system for safekeeping Residents moneys is currently limited as senior staff only have access to amounts of money held in a “float” tin and not to the actual amounts held on behalf of Residents. Should several Residents wish to withdraw large amounts the float does not contain sufficient amounts and the Residents would be faced with a wait until the Manager or Administrator was available to release funds. The systems for safekeeping of Residents personal allowances showed that one Residents money is held in a Local Authority bank account and not in an account in the Resident’s own name. This system is not in the Resident’s best interests, there is no interest payable on the amount held. Records did not contain all the receipts for hairdressing services. Residents are not asked to sign for small withdrawals and staff signatures were not recorded against all transactions. Residents meetings are held and surveys have been undertaken to obtain Residents and relatives’ views on the service. Fire records showed gaps in the testing weekly testing of the overall fire system. The accident records were not fully detailed and did not include arrangements for the monitoring Residents following an accident. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 2 3 3 3 3 2 3 STAFFING Standard No Score 27 2 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 3 3 3 3 3 3 3 2 3 2 3 OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 22 No 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 19 Regulation 23 (1) (a) & 2(a) 15 (1) Requirement An action plan must be submitted with proposals for appropriate accomodation for Residents with Dementia. Care planning must be developed to reflect all areas of need and include detailed instructions for staff on how the care is to be provided. Medication Cabinets must be kept locked at all times when left unattended. The serving of meals must be reviewed to ensure food temperatures are maintained. Written confirmation of arrangements is to be forwarded to the Commission. The wall at the front entrance must be repaired. Written confirmation that this work has been completed is to be forwarded to the Commission. Corridor areas must be redecorated and written confirmation that this work has been carried through is to be forwarded to the Commission. Repairs must be carried through to Ceilings damaged by water ingress and written confirmation Timescale for action 30.6.2005 2. 7 31.7.2005 3. 4. 9 12 13 (2) 16 (2) (i) 16.5.2005 15.6.2005 5. 19 23 (2) (b) 30.6.2005 6. 19 23 (2) (d) 30.6.2005 7. 19 23 (2) (b) 30.6.2005 OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 23 8. 19 23 (2) (d) 9. 27, 28 18 (1)(a) & 12.1.(a) 20(1) (a) 10. 35 11. 38 23(4) (c) (v) that this work has been carried through is to be forwarded to the Commission. Ceilings stained by water damage must be re-decorated and and written confirmation that this work has been carried through is to be forwarded to the Commission. Staffing levels must be increased to meet the needs of the Residents and provide adequate supervision and monitoring. The Registered Person must ensure that money belonging to Service Users is paid into individual bank accounts and written confirmation that this work has been carried through is to be forwarded to the Commission. The Testing of the Fire System must be carried through weekly. 30.6.2005 30.6.2005 30.6.2005 16.5.2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 19 19 19 Good Practice Recommendations Consideration should be given to improving and making safe the garden areas including attention to providing safe ramps, patio areas and pathways around the Home. Consideration should be given to safe storage of Hoists. Consideration should be given to improving the layout of the Laundry area and to a providing a further Tumble dryer. OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Newland House, 1st Floor Cambell House Northamtpon NN1 3EB 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 OBELISK HOUSE DC51 S35721 Obelisk House 160505 V223457 stage 4.doc Version 1.30 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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