Inspection on 20/07/05 for Orchard House (Sawston)

This inspection was carried out on 20th July 2005.

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

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

Other inspections for this house

Orchard House (Sawston) 03/06/08

Orchard House (Sawston) 20/07/06

Orchard House (Sawston) 12/04/06

Orchard House (Sawston) 18/11/05

Orchard House (Sawston) 28/02/05

Orchard House (Sawston) 28/07/04

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

CARE HOMES FOR OLDER PEOPLE Orchard House 191 High Street Sawston Cambridgeshire CB2 4HJ Lead Inspector Shirley Christopher Announced 20 July 2005 @ 10:00 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. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Orchard House Address 191 High Street Sawston Cambridgeshire CB2 4HJ 01223 712050 01223 712052 n/a Methodist Homes for the Aged 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) Ms Alison Baggaley Care Home 35 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (20) of places Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The minimum daytime staff to resident ratio will be 1: 10 for those residents in the OP category and 1:5 for those residents in the DE(E) category Date of last inspection 28 February 2005 Brief Description of the Service: Orchard House is situated in the village of Sawston, with easy access to local facilities, and road and rail links to the City of Cambridge, Linton and Haverhill. Orchard House provides residential accommodation for up to thirty-five service users over sixty-five. Their current registration certificate enables them to provide accommodation for up to fifteen people with dementia. There is a purpose built unit on the ground floor. The first floor is for service users who need residential care. There is a third unit offering respite care. On the same site there is a purpose built day centre, which can be used by the home, and by older people from the local community. The home has transport for the benefit of the day service. On the same site is a sheltered housing unit, which provides independent accommodation to more able service users. Accommodation is managed by a housing society and care needs are met by Methodist Homes for the aged. This service is managed separately from Orchard House and is subject to seperate registration with the CSCI as a domicillary care provider. The home provides accommodation, which meets the National Minimum Standards in terms of room sizes. The home has thirty-five single bedrooms, some of which on the first floor offer en-suite accommodation. The home has accommodation on two floors, which is accessed by stairs of a lift. Keypads are fitted on the internal doors of the dementia care unit to provide some security. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place at 10.00 am on the 20 July 2005 until 4.45 pm and was announced. The assistant manager returned a pre inspection questionnaire and a self-audit form before the inspection took place. This provided evidence of how the home are meeting certain standards. On the day of inspection the home was fully staffed and seven care staff were spoken to excluding the manager. Three visitors were spoken to and seven service users. Some documentation was inspected including, four care plans, menus, four staff files, contracts, the service user guide complaints and adult protection policies and procedures, fire records, water temperatures, staffing rotas, training records, supervision notes and staff appraisals, staff meeting minutes and relative meeting minutes, service user finance, financial accounts and the quality assurance forms and report. Most were satisfactory. Recent reports completed by Social Services after their audit and the environmental health report were also inspected. Comment cards were sent to relatives/visitors and service users before the inspection. Twenty-four were returned and mostly responded positively to the questions. Most chose not to make additional comments. The comments made are summarised in the relevant sections. What the service does well: The home provides spacious accommodation for up to thirty-five service users, who have a variety of needs, for which there are designated units. A number of service users come in for a short period of respite care and then at a later stage are admitted as permanent residents. This gives them the opportunity to be gradually introduced to the home and have experience of the service before admission. There is also a day centre on site, which can be accessed by permanent service users. Staff records demonstrated that staff receive a good induction programme, adequate training opportunities and regular supervision. Monthly staff meetings are held and the home is currently doing annual appraisals for all their staff. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 6 The home has a good system for monitoring their performance, through internal audits and questionnaires to ascertain service users, staff and other stakeholders views of the service. What has improved since the last inspection? What they could do better: Historically there have been difficulties in recruiting staff. This situation has improved but a high percentage, twelve out of the seventeen relatives/visitors felt that there was insufficient staff on duty at particular times of the day. Care staff spoken to at the inspection echoed this. Care staff stated it had got better but at times they were left on their own in the unit and felt that the needs of the service users particularly on the dementia care unit had changed. Higher dependency levels meant that staff felt that there was insufficient time in the day to meet much more than just the physical care needs of service users. Other staff members cited poor team- work as a concern. Care staff also stated that more support from members of the management team would be appreciated particularly at busy times of day. The dementia care unit smelt strongly of urine and despite the efforts of the domestic staff this was raised as a concern by several relatives. A domestic vacancy had been recently filled, and temporary cover had been provided Care plans provided good information, but this information was not always up to date. Evidence of monthly reviews was not seen on the files inspected. Some important omissions were noted, where a care need had changed and this had not been fully documented. Risk assessments and manual handling assessments, had not been updated after a fall. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 7 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 I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 The home has adequate admission procedures and an information pack is given out. EVIDENCE: Evidence of comprehensive assessments completed by both the home and other agencies were seen on the files inspected. Contracts or terms and conditions are issued depending on the funding arrangements. The home does not provide intermediate care, but the manager stated that they do accept emergency admissions to one of the respite care beds. Introductory visits may be possible, but the majority of service users already know the home through attendance at the day centre, from Bircham House or as a respite care admission. The home has an information pack they give out to prospective service users. The statement of purpose requires updating annually and the complaints procedure contained within it should be changed to state that complaints could be referred to the CSCI at any stage. The service user guide was not inspected. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 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) 7,8,11 Care plans provided adequate information about how service users needs should be met, but information must also reflect changing and unmet need and be regularly updated. EVIDENCE: Four care plans were inspected and generally provided good information in terms of meeting service users physical, emotional and social care needs. On each file inspected there was basic information, a pre admission assessment, and care plans covering most areas and including a brief social history. Medical information is kept separately and provided evidence of appropriate use of other health care services. Care staff are key workers to a number of different service users and it is up to them to ensure records are up to date. Care plans are required to be reviewed monthly, but there were some significant gaps. Changes in dependency levels as a result of a fall or injury were not automatically recorded, or risk assessments, manual handling assessments and care plans updated accordingly. No evidence was provided of preventative measures put in place after a fall, although the home do keep a record of accidents and produce statistical information of the number and type of falls. The home has also been in contact with the falls prevention coordinator for Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 11 advice. Some information was not recorded on file, in particular standard 11 which look at the service users last wishes. Service users spiritual needs are recorded. On another file a service user had a specific type of dementia in which he may experience hallucinations. A care plan should be in place for this. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 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) 12,13,15 Appropriate social activities are provided but the frequency of activities was not fully explored during this inspection. EVIDENCE: The home has a separate day service which some of the service users from the home attend. Day trips are planned on occasion; examples of forth coming events are highlighted in the newsletter and discussed in the various meetings. Events include summer outings, church services and a strawberry tea. Ongoing efforts are being made to recruit volunteers. The home has two part time activity coordinators who work on alternative floors. No evidence of social activity was seen on the day of inspection, other than interaction between staff and service users, and music in the background. The home has a separate hairdressing room. This was being used. There are plans to create a sensory garden for the dementia care unit, which at the moment is paved in parts, and acts as a barrier for some service users. New plans will include a water feature. Some money is already available. Evidence of daily, structured social activity was not seen and some care staff felt they did not have adequate time to spend with service users, other than to carry out basic personal care tasks. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 13 A meal was observed and was appropriately served. Service users were sat in small groups and received one to one assistance from staff. They were offered a choice, a main meal and pudding and a drink. No complaints were made about the food. The kitchens were not inspected as part of this visit. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 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) 16,18 There are policies and procedures in place for dealing with complaints and the protection of vulnerable adults. EVIDENCE: A number of complaints have been received since the last inspection. Copies of these complaints are kept and had been appropriately responded to within the given timescales. Evidence of training in the protection of vulnerable adults was provided. Policies and procedures are in place, but were not requested. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 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) 19,20,21,22,23,24,25,26 The home is brightly decorated and spacious, with no immediate hazards identified. EVIDENCE: Orchard House provides purpose built accommodation, which is light, airy and spacious. Bedrooms are of adequate size and some provide en-suite facilities. Each floor has designated accommodation for service users with different needs. The dementia care unit has keypads on the internal doors to prevent service users wandering off the unit. The areas are divided up to create two separate lounges/dining room, which also have a separate kitchen where staff can prepare snacks and drinks. There are specially adapted baths and adequate toileting facilities. There is also a small a room for staff to go for a break and this is where the care plans are kept. The unit overlooks the garden on several sides. It is currently very attractive with a paved pathway round the garden and clumps of flowers, particularly lavender. However some service users are reluctant to go outside and it was felt by the manager that the path way might act as a barrier for service users with visual or other impairments. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 16 Some monies have already been secured to turn it in to a sensory garden with a water feature. The home had a number of recent inspections from Social Services contract team, the environmental health service who looked at the kitchens and the fire authority. A report was seen from the first two agencies. Both were satisfactory. Fire records and water temperature records were inspected and were satisfactory. Some relatives and one service user raised two concerns; one was about the passenger lift, which had been out of order for two weeks, whilst waiting for a major part. It is now in full working order. Also some complained about a strong odour of urine on the dementia care unit. This was discussed with the manager and it was agreed that some steps were already in place to reduce odours, such as deep cleaning the carpets at regular intervals and replacing carpets with non-slip flooring where appropriate. It agreed that more should be done including reviewing and replacing carpets and soft furnishing when necessary. Eighty domestic hours a week is provided, but the dementia care unit has been without a domestic for a while, and other domestics have been covering the unit, whilst a new person has been recruited. The cleaning schedules and toileting of service users should be reviewed. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 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) 27,28,29,30 The home has good recruitment, induction and staff training available ensuring that staff have the skills to meet the needs of the service users. EVIDENCE: Evidence was provided of good staff induction, training and support in terms of regular supervision every six weeks or so, monthly staff meetings and yearly appraisals which have just been implemented. Senior staff complete a twiceyearly internal audit, which look at different aspects of the service and incorporate the views of staff, service users, relatives and visitors to the home. Four staff files were inspected and provided evidence that thorough staff recruitment procedures are in place and documentation required by regulation 19 is obtained prior to the employment of staff. However on two staff files there were no written references. A satisfactory explanation was given for one of these members of staff who had transferred from another home run by Methodist Homes. The manager must audit all staff files to ensure that the correct information is on file Staffing rotas were inspected and it was found that staff are employed in sufficient numbers, to satisfy the minimum staffing levels, but these may need to be reviewed according to the dependency levels of the service users. Arrangements for staff breaks and handovers should not interfere with the smooth running of the home and the skills mix of the staff should be kept under the review. The homes management have been proactive in recruiting Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 18 staff and have no vacancies. Regular recruitment and open days have been met with some success. Staff commented that the use of agency staff is kept to a minimum. The manager was reminded that surnames of all staff must be included on the staffing rotas and where agency staff are being used. The manager must ensure that confirmation is put in writing from the agency that all their staff are properly vetted. The home has until the 31 December 2005 to meet the NVQ targets. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 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, 33,34, 35,36,37,38 Generally the standard of record keeping are good and there are systems in place to identify areas of good and poor performance within the home. EVIDENCE: The manager has just completed her NVQ 4 and is waiting for it to be internally audited. She already has considerable experience in this field and has a relevant qualification in management. She has kept herself up to date professionally and has undertaken specific study. She has completed a train the trainer course in dementia. She has recently spent a period of time off sick, but has three assistant managers in post. One assistant manager is leaving this week and a replacement has already been recruited to the post. A number of care staff were spoken to about the management arrangements in the home and staff stated that it would be helpful if senior managers could Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 20 come on to the units more frequently particularly at key times of the day to help at busier times, rather than supporting at arms length. Mechanisms of staff support were in place and the frequency of staff supervision, appraisal, meetings and training was appropriate. The home has a detailed quality assurance policy and the home complete a six monthly internal audit. The results are used to identify areas where the home performs well and areas where the home could improve. The manager does an action plan to state how any short falls will be dealt with. The home sends out questionnaires to service users, visitors/relatives. Some financial accounts were seen looking at the homes monthly income and expenditure. These were satisfactory. The homes business plan and insurance certificate were not inspected. Small amounts of personal allowance are held on behalf of service users. Monies are stored correctly and appropriately accounted for. Only records were checked and not the cash balance. Most records inspected were satisfactory and included, four care plans, menus, four staff files, contracts, the service user guide complaints and adult protection policies and procedures, fire records, reports from the Social Services audit and environmental health report, water temperatures, staffing rotas, staff training, supervision and appraisals, staff meeting minutes and relative meeting minutes, service user finance, financial accounts and the quality assurance forms and report. Other documentation used as evidence was the pre inspection questionnaire, service user/relative/visitor comment cards and the homes self audit. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 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 2 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 2 4 3 3 4 2 3 Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 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. 2. Standard 1 7 Regulation 4/5 15(2)(b) Requirement The statement of purpose must be kept under review and revised accordingly. Care plans must be reviewed on a regular basis and reflect changing needs. Other documentation particularly risk assessments and manual handling assessments must also be updated when required. The premises must be kept clean and free from offensive odours. Staffing ratios must be kept under review according to the assessed needs of the service users and the skills mix of staff must be appropriate to their needs. The full name of each member of permanant and agency staff must be kept at the home. Staff files must include two written references. Where agency staff are employed the manager must ask for written confirmation from the agency that all staff they employ are properly vetted. Timescale for action 31 August 2005 31 August 2005 3. 4. 26 27 16(2)(k) 18(1)(a) 31 August 2005 31 August 2005 and ongoing 5. 6. 27 29 17(2) Schedule 4 19(4) (i) 31 August 2005 31 August 2005 7. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 23 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. Refer to Standard 11 Good Practice Recommendations The home should ascertain what the service user wants in planning for and dealing with increasing infirmity, terminal illness and death. Orchard House I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 STAGE 4.doc Version 1.30 Page 24 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE 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 I03 I53 S15174 ORCHARD HOUSE (SAWSTON) V230322 200705 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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