Inspection on 14/03/06 for Orchard House

This inspection was carried out on 14th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard House 14/04/09

Orchard House 01/05/08

Orchard House 03/05/07

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Orchard House Ashford Road Kingsnorth Ashford Kent TN23 3ED Lead Inspector Nicki Dawson Unannounced Inspection 14th March 2006 12:50 Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 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 Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard House Address Ashford Road Kingsnorth Ashford Kent TN23 3ED 01233 612234 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) CareTech Community Services (No.2) Ltd Vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users who are over 65 years of age to be restricted to one (1) whose DOB is 07/01/1925. Service users who have acquired brain injury to be restricted to one (1) whose DOB is 23/10/1940. Date of last inspection Brief Description of the Service: Orchard House is registered to provide accommodation for up to 9 adults with a learning disability and admits people with medium to high dependency needs. The home caters for 5 residents downstairs that have a sensory impairment as well as a learning disability. The upstairs caters for two residents that have a learning disability, one that has an acquired brain injury and one that is over 65 years old. The company CareTech Community Services Ltd owns the business. The manager who has day-to-day control of the home took up post in February 2004 and is not yet registered with the Commission. The premise is a detached property with all single bedrooms. The residents have the use of 4 bathrooms. Each unit (upstairs/downstairs) has a kitchen, dining room and lounge. There is no lift access. All rooms have a television point. There is a large garden available to the residents at the rear and a parking area to the front. The Home is situated in the village of Kingsnorth, which is approximately 2.5miles from Ashford town centre. Within 100yds there is a bus stop and a village pub. The home also has transport, which can be used for residents if they wish. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on Tuesday 14th March between 12.50pm and 19.10pm. Most of the residents are unable to speak and therefore it was not possible for them to say what they thought about living in the home. The Inspector spoke with one senior support worker, four support workers and the manager. Various records were looked at and the inspector walked around all the main areas of the home and some residents bedrooms. The inspector looked at how staff communicated with the residents. What the service does well: 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. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Not all of the individual care needs of residents are recorded and met which underestimates the highly complex care needs of the residents and could potentially put them at risk. EVIDENCE: The residents who live in the home have highly complex care needs and most are unable to communicate verbally. This is not reflected in the detail contained in each residents care plan. The process of developing a goal plan for each resident has been started, but limited progress has been made. Staff have a good understanding of the care needs of the residents, but did not find the care plans easy to follow. For example, information about one resident is contained in two files, which the staff found confusing. There are strategies in place to minimise the potential risk to residents. However, staff commented that one strategy was not carried out in practice. Care plans and risk assessments are regularly reviewed. Due to the communication needs of the residents, one to one talk time with staff is implemented and recorded. This practice is commended. Limitations on residents rights have been recorded in each residents care plan and a copy sent to the placement officer for agreement. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 9 Where the home is involved in looking after monies on behalf of a resident, clear records are kept of all financial transactions. There is a clear written procedure for handling resident’s monies, including the charging of residents for mileage when they travel by car in the community. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14 The limited numbers of staff that drive, combined with lower staffing levels at the weekend, result in restricting the lifestyle opportunities for residents. EVIDENCE: Activity programmes are in place for each resident with activities opportunities such as tactile sessions, sensory cooking, going out in the community, swimming, and attending the local day opportunities centre and a sensory room in Folkestone. Staff now record when a resident does not take part in a planned activity. Activity sheets are comprehensive in that they include the time of the activity, staffing levels required and the amount of participation by the resident involved. The opportunities for residents to go out in the community are restricted. One member of staff said, “I would like to see the residents out a bit more, but there are not enough drivers”. At the weekend, when there is less staff on shift, staff said that they are unable to take residents out of the house and instead they involve residents in in-house activities. One member of staff Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 11 summed up residents lifestyle by saying that the home, “attempt to give residents a complete quality of life”. On the day of the inspection two residents had gone out to visit the rare breeds centre and one resident was supported to go to the shops. Other residents received interaction from staff via touch and one resident played some musical instruments. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Limited progress has been made on improving the arrangements to ensure that all the healthcare needs of residents are met. This shortfall has a potential to place residents at risk. EVIDENCE: Sampling of residents health care records indicated that although residents had regular appointments with the optician and chiropodist, two residents had not attended the dentist for over two years. This was highlighted at the previous inspection. The manager explained the reason for one resident not attending the dentist, but this had not been recorded in the care plan or health record. Clear records are kept of residents who have seizures and a training plan is in hand to train all staff to support people who have epileptic seizures. Selected aspects of the ordering, storage and administration of medications were inspected. Only senior staff administer medication and they demonstrated that they knew what to do if a medicine was administered in error. The home’s procedure for the administration of medication is out of date since it refers to two staff administering medication. Staff said that they would be attending a more comprehensive training programme on medication in the near future and this is welcomed. Good records were kept of the administration of medication, with one exception, where a hand written entry on the medication administration record had not recorded correctly. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 13 Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Limited progress has been made towards ensuring that residents are protected from abuse. EVIDENCE: To ensure residents are protected from abuse, neglect and self-harm the home should have a clear flow-chart of how to report abuse both inside and outside of the company. Any policy on the protection of adults from abuse should refer to the Kent and Medway Adult Protection Guidance from the local authority. This is outstanding from previous inspections. Staff demonstrated that they would report any suspicion of abuse internally, but were not all aware of how to report abuse to other agencies. Residents must be safeguarded by clear written guidance to staff regarding physical intervention. The type of physical intervention that is used in the home is recorded, but it has not been agreed by a multi-professional team as stated by the home’s policy. There must also be written guidance for staff that have not undertaken NVCI training and for agency staff. This is outstanding from the previous inspection. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 Some progress has been made to providing residents with a suitable environment in which to live which impacts on the quality of life that they experience whilst living in the home. EVIDENCE: Orchard House is a detached property that is divided into two separate units, with one downstairs and one upstairs. The staff team provide support for residents in both units. Each unit has a kitchen, dining room and lounge. All residents are provided with single rooms. There is no lift access. There is a large garden available to the residents at the rear and a parking area to the front. The Home is situated in the village of Kingsnorth, which is approximately 2.5miles from Ashford town centre. Within 100yds there is a bus stop and a village pub. The home also provides transport. There has been a general improvement to the environment since the last inspection. The home was light, well ventilated and generally warm. However two of the bathrooms felt cold by comparison to the rest of the home. Additional furniture has been purchased for the dining room, so that residents and staff can be seated at mealtimes. The concrete area at the rear of the property has had weeds and brambles removed and a large garden is available for residents. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 16 Staff confirmed that the both kitchens are now used to cook residents’ meals and therefore, the residents upstairs do not have come downstairs for snacks and meals. The cooker in the downstairs kitchen is not adequate to cook for residents and staff. Consideration to replace was strongly recommended by the EHO and at previous inspections. The manager is in the process of trying to address this. Generally, the home was clean on the day of the inspection and improvements have been made in maintaining the standards of hygiene within the home. The milk dispenser has been cleaned and the area around the clinical waste bin in the bathroom has been tiled to ensure that it is hygienic. In one toilet where the water has been disconnected alternative hand washing facilities have been provided. However, the manager advised that although the worktop in the kitchen area was replaced it is again worn through and is unhygienic. This is an ongoing problem in the home that has yet to be resolved. A number of bins have their lids missing. The laundry facilities of the home are not adequate to meet the resident’s needs. There is an outstanding requirement to submit suitable plans for a new laundry to the Commission for Social Care Inspection. The current plans discussed with the manager were not suitable. The upstairs dining room continues to be used as a smoking room, which is not ideal particularly in relation to other resident’s health. The manager explained that there are plans to build a smoking shelter on the ground floor and the inspector looks forward to the completion of this project. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 33 Limited progress has been made towards providing residents with a stable, competent, appropriately trained and qualified staff team that can meet their needs at all times. EVIDENCE: Staff demonstrated that they were motivated. “I enjoy working here with the guys”, said one member of staff. Throughout the inspection staff were observed using touch to interact and with the residents in a way that was comfortable to both participants. A number of residents have additional funding for one to one staffing levels and require two members of staff to support them when they go out in the community. The manager explained that the staff member allocated to each funded resident is now recorded in the coordination sheet each day. However, it was not recorded for the day of the inspection. Staff said that they felt that they received the training necessary to undertake their role within the home. A training matrix has been established which shows a commitment by the home to train all staff in epilepsy and Makaton. It is important that this also includes agency staff that permanently work in the home. This has not been achieved to date. The training programme does not include training in sensory impairment or acquired brain injury. The manger explained that she is finding it difficult to access local training on acquired Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 18 brain injury. Until such training can be obtained the inspector advises that the home develop a training and information pack on the subject for all staff to access. The staff rota indicated that between 7.30am and 10pm there is one senior and four support staff on duty. During the week, when residents are funded for one to one support, this can rise to an additional one or two support staff on duty. This extra staff support is not available at the weekend and can have a negative impact on residents’ opportunities to go out in the community. There are two waking night staff. At the last inspection it was suggested that the manager use a formal assessment tool to identify staffing levels based on residents assessed needs. The staff team as a whole is still relatively new. The majority of staff on the day of the inspection had worked at the home for less than a year. There has historically been a high staff turnover in the home and this has acted to the detriment of the residents some of whom staff explained, “exhibit with a high turnover of staff due to hearing different voices”. The home currently has five full-time vacancies, which it covers mainly by the use of two consistent agency staff. The manager said that she had recruited five new staff members since the last inspection, which has gone a long way towards establishing a stable staff team for the residents. As it was stated at the last inspection, the needs of the residents at Orchard House are highly complex and the importance of a stable staff team with the right skills particularly when residents are unable to communication verbally cannot be given a high enough priority. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 There are major shortfalls highlighted in this report, which affect the safety and welfare of residents. EVIDENCE: At the last inspection the manager was required to address the maintenance of the electrical wiring in the home. It was clearly pointed out to her that the last Periodical Electrical Test, which was dated 21/01/03 was only valid for one year. The Manager stated that she thought that the work had been done, but had no certification to provide evidence that work had been undertaken to address the safety issues. The fire record indicates that regular maintenance of fire fighting equipment is undertaken. Fire drills take place, but the name of each staff member is not recorded to ensure that each staff member takes part in fire drills twice a year. The fire safety officer has now agreed the home’s fire risk assessment. The problem of door closures and fire safety has also not been addressed. Residents are still wedging their doors, which does not provide adequate protection if a fire breaks out in the home. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 20 The first aid box was well stocked. Bath temperatures are recorded before residents take a bath to ensure that they are safe. There is a training matrix that includes staff training in all statutory areas. There are a number of staff that have still not been trained in fire safety, moving and handling and food hygiene. Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 2 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 1 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 3 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 2 X X X X X X 1 X Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 22 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 YA2 Regulation 14(1) Requirement Obtain copies of the Care Management assessment of residents needs (previous timescale of 30/01/04 and 31/10/05 not met) Care plans and risk assessments must contain sufficient detail to enable staff to meet residents assessed needs and aspirations and evidence these needs are being met (previous timescale 30/09/05) Residents have increased opportunities to access the community and appropriate leisure activities (previous timescale 30/08/05) All residents to receive treatment and advise from a qualified dentist Where hand written entries are made on the MAR sheet they should be signed, counter signed and the amount of medication received entered on the record Timescale for action 14/05/06 2 YA7YA9 15 and 13 (1) c 14/05/06 3 YA12YA13YA14 16 14/06/06 4 5 YA19 YA20 13 (1) (b) 13 (2) 14/05/06 21/03/06 Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 23 6 YA23 13 7 YA23 13 (6) 8 YA30 13, 16 9 YA30 23 10 YA33YA32 18 11 YA42 23 4 (a) 12 13 YA42 YA42 13 4 (e) 13, 23 Intervention guidance to staff must be specific in detail for those trained and not trained and be agreed by a multi-disciplinary team. (Previous timescale of 30/09/05 not met) Review managing abuse policy to ensure staff are clear when/how to report incidents/accidents to outside agencies (brought forward from two previous inspections The home must be kept clean and hygienic with reference to bins and the kitchen worktop (previous timescale of 30/08/05 not met) Provide the Commission with a timescale for redevelopment work which will incorporate more suitable laundry facilities (previous timescales 31/12/04 and 30/09/05 not met) Sufficient, suitably qualified, competent and experienced staff are working at the home to ensure the needs of the residents are met (previous timescale 31/3/05 and 30/10/05 not met) Fire guards to be provided to residents bedrooms to prevent fire doors being wedged open Staff names to be recorded when they take part in a fire drill Comply with Health & Safety legislation by maintaining the electrical installation equipment (previous timescale of 30/08/05 not met) 14/05/06 14/05/06 14/04/06 14/05/06 14/09/06 14/04/06 21/03/06 21/03/06 Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 24 14 YA42 23 4d; 13 (5); 16 2j All staff to be trained in fire 14/09/06 safety, moving and handling and food hygiene 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 4 5 Refer to Standard YA28 YA26 Good Practice Recommendations 6 7 8 9 A separate smoking area to be provided for residents Bedroom furniture is audited against the standards and choices recorded (brought forward from 2 previous inspections) YA27 The cooker is replaced with one that is large enough to cook for the numbers required (brought forward from 2 previous inspections) YA33 Staff undertaking the 1:1 additional funded hours to be identified to ensure maximum benefit for the resident YA32YA33YA35 Further staff to receive specialist training specific to the residents needs/disabilities i.e. acquired brain injury, sensory impairment, Makaton, epilepsy and physical intervention YA32 A training pack be developed with information about acquired brain injury whilst formal training is being sought YA33 A formal assessment tool is used to identify staffing levels based on residents needs YA34 Two senior staff should interview prospective employees to ensure equal opportunities. YA39 Quality monitoring to include feedback from all stakeholders and be used to feed a development plan Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Orchard House DS0000065346.V286365.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!