Inspection on 29/01/07 for Paks Trust Hatfield House

This inspection was carried out on 29th January 2007.

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

The inspector 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Paks Trust Hatfield House 24/02/09

Paks Trust Hatfield House 16/02/06

Paks Trust Hatfield House 21/07/05

Paks Trust Hatfield House 10/02/05

Paks Trust Hatfield House 14/09/04

Paks Trust Hatfield House 03/03/04

Paks Trust Hatfield House 18/09/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Paks Trust Hatfield House 17 New Road Ash Green Coventry West Midlands CV7 9AS Lead Inspector Martin Brown Key Unannounced Inspection 29th January 2007 3:00pm Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 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 Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Paks Trust Hatfield House Address 17 New Road Ash Green Coventry West Midlands CV7 9AS 02476 362326 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) PAKS Trust Joy Rebecca Lewis Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. NVQ level 4 That NVQ level 4 in care and management is achieved by 2005. 16th February 2006 Date of last inspection Brief Description of the Service: Hatfield House is a detached mid twentieth century house situated on a corner of a cul-de-sac in a residential area with garden at the front, side and rear. The house has an entrance porch, which serves as cloakroom and smoking area; dining room, lounge, kitchen and utility/shower room and one residents bedroom on the ground floor. Stairs lead off the dining room to the first floor where there are four bedrooms for residents and a bathroom and toilet. There is a very large garage at the back of the property and parking for three cars. The home is close to some local shops and a bus route. The current fees for the home range from £590 to £800 per week. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been made using evidence that has been accumulated by the Commission for Social Care Inspection. This includes information provided by the home, and a visit to the home. Questionnaires from all the residents were received, which had been completed by residents, with the acknowledged help of staff, or, in one case, a relative. Three comment cards were received from relatives. Two were positive, but concern was expressed about information regarding residents not being communicated. The pre-inspection questionnaire was completed and returned by the manager. The inspection visit was unannounced, and took place on January 29th 2007, between 3pm and 6pm. The manager was not present during the inspection, but was spoken with later in the week by telephone. A tour of the premises was made, relevant documentation was looked at, staff and residents were spoken with, and interactions between staff and residents observed. The three residents were ‘case tracked’, that is, their records and experience in the home were examined in detail. Staff and residents were welcoming and helpful throughout. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that individual care records accurately record care needs and how they are met, to ensure that these are reviewed and maintained in order to reflect and inform changing needs of individuals. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 6 At present, any new staff would be reliant on existing for much of the information concerning residents, rather than being able to read it in clear, upto-date care plans. Consistency of action, support and care is compromised if relevant information is not fully recorded. The service should not rely on the individual knowledge of staff as a substitute for properly recorded, accessible and up-to-date care plans, which should detail likes, dislikes and particular interests, as well as care and social needs, and be, as far as possible, accessible to residents themselves in some form or other. The service should ensure in future that funding agencies are clearer and more transparent concerning the futures of any short term or emergency. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 7 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 Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment of needs of prospective residents have been seen on previous occasions, and there is no reason to think that this would not continue to be the case. Clarification with funding agencies on the likely outcomes of any future short term or emergency placements would help to avoid uncertainty and distress in such cases. EVIDENCE: There have been no permanent new residents admitted since the previous inspection, when admissions procedures were seen to be satisfactory, and involved visits and introductions. One resident was admitted on an emergency temporary basis, and subsequently remained for over six months, during which time, staff advised, she became fully settled and a much-liked resident in the home. Staff advised that she was reluctant to leave, and became extremely distressed when told she had to move to another home. Staff spoken to felt this move was badly handling by the funding agency, and was done for financial reasons, with no heed given to the residents’ wishes, and little attempt to adequately explain any reasons for the move being necessary. The staff spoken to stated that the process of the move was distressing for all concerned. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans that are incomplete or inconsistently completed do not assist in recognising or meeting care or other needs. Consequently, the service’s ability to effectively meet residents’ needs is reliant on the knowledge of a small staff team who are familiar with the residents and their needs. Any new staff would not receive the required guidance and support from the existing care plans, and even existing staff may not always work consistently without clear guidelines. Staff were able to show their personal knowledge of individual needs and how to meet them. Residents are able to make choices and take risks. A life story book, or similar, would be of benefit to one resident who does not have such a document. EVIDENCE: The care plans of all three current residents were examined. Care plans appear incomplete, with some parts having sufficient detail, and other parts containing little information, or being blank. Each care plan contained typed headed sheets on a wide variety of subjects, primarily to do with health needs. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 10 Some of these were not relevant to the needs of the resident, such as a sheet headed ‘pressure sores’, which was blank. There was no evidence or reason to suppose that this person was at risk from pressure sores. The care plan for one resident appeared to be incomplete. The ‘health check sheets’ were filled in, but other sheets contained very little information. One sheet detailing medical checks on another resident had no details concerning dental visits. Staff informed me that this person refused to visit the dentist. This fact was not recorded, nor were details of any plan to try and persuade him of the benefits of such a visit. In contrast, this person’s refusal to have a ‘flu jab’ was clearly documented. It was noted that an optician’s appointment for this person was due in November 2006, but there was no record of whether this had happened or not. The mobility of one resident had greatly reduced following a fall but there was no evidence of a review of his care needs to reflect this. He was later observed mobilising with the support and encouragement of staff. Staff said that they knew, from working regularly with him, what level of support he required, but admitted that without clear, up-to-date guidelines, a consistent approach was compromised. Some medication changes were recorded in care plans, but others appeared not to be. These were later noted in the medication records kept with the medication. One resident, when asked about his care plan, said he had no idea of such a document. Staff advised he had been aware of his care plan, but tended to be forgetful. Another resident was aware of his, and also had a more ‘user friendly’ life story folder in his room, which he showed me. One more recent arrival, who was less able to tell me all about himself, did not have such a book. Staff agreed that such a file/book, containing photographs, and details of his life, his preferences and dislikes, would be a useful document, both for his own interest, and as a way of helping communicate his needs and wishes to others. Residents continue to be offered choices and to make decisions in a wide variety of ways, from what, where, and when they have the evening meal, to what they do in the evenings and in the day. Residents are supported in risktaking, with risk assessments seen to be in place in individual care plans. Residents did not appear to have had care management reviews led by social services for well over a year in some instances. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy pursuing individual activities and interests, enjoy appropriate relationships, have their rights and responsibilities respected, and are offered a healthy and varied diet. EVIDENCE: Residents continue pursue their individual interests. One resident has a particular interest in aircraft and military books and pictures, and was pleased to show me these. Another resident has a wide variety of interests and activities, and is an accomplished painter. One resident was looking forward to going out to a local pub in the evening with his family. Residents are active around the house in line with their abilities and wishes. One resident was able to safely ‘keep an eye’ on the tea cooking whilst the staff member was away from the kitchen for a short while. Another resident was able to safely make a cup of tea. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 12 Residents enjoyed a freshly prepared meal. A choice was available. The fridge and freezer and cupboards were well-stocked, and menu plans indicated that a good range of healthy food was available. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents get support in accordance with their needs and wishes, and are supported and protected by the home’s practice and procedures in respect of medication. EVIDENCE: One person was supported and guided to use the toilet, another was encouraged to help in the kitchen, and one person was advised about, but allowed to get on with, making a cup of tea. Staff showed a good knowledge of individual care needs, although this was not always clearly recorded in individual care plans. All residents said that they were happy at the home, and were complimentary about the staff and the help and support they provided. Discussion with staff demonstrated that particular health issues had been dealt with properly, with the support and involvement of outside staff, although, again, this was not always clear from individual care records. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 14 Medication administration and recording was looked at and was seen to be satisfactory. Consents, and assessments for self-administration were in evidence, as well as details of medications that were subject to change and review in line with medical guidance and monitoring. There were no accompanying details of what individual medications were for, but the staff member was able to explain these. Similarly, there were no recorded details as to where and for what purpose a topical cream was to be applied, but the staff member was able to fully explain this. She acknowledged that this may not be evident to any newer staff, and that, as good practice, such details should be recorded. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service works to protect the residents from abuse and neglect, and residents feel that their views are heeded. An instance where the wishes of a resident appears to have been overridden appears to have been caused by decisions made outside the home’s influence. EVIDENCE: One relative had noted in a comment card that they had made a complaint, but it had been swiftly and satisfactorily resolved. Residents all said they were happy at the home and had no concerns regarding the staff. The only concerns expressed by a resident were concerning the behaviour of another resident, who has since left the home. One relative, although happy with the general level of care within the home, expressed concern at not always being kept informed of issues concerning the welfare and well-being of her relative who is resident in the home. Staff informed me of the events where a resident, who had been admitted on an emergency basis, stayed for six months and did not wish to move when the funding agency identified a new placement. Staff felt that she was made to move, against her wishes, for primarily financial reasons. Financial records were seen to be satisfactory, with money handled for residents being fully recorded, and with residents having access to some monies independent of the service. Staff advised that residents have use of a vehicle provided by the organisation, to which they contribute towards petrol costs for leisure use. Contributions were recorded in individual records. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 16 One staff had left earlier in the year, before the conclusion of an investigation concerning inappropriate behaviour. The circumstances surrounding this were explained, and appropriate action had been taken, including a referral to POVA (Protection Of Vulnerable Adults). Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to be a comfortable, ‘homely’ one, much appreciated by the residents. Secure storage of all potentially hazardous materials within the garage may make this facility more accessible to residents. EVIDENCE: The home continues to be well maintained and domestic in scale. Pictures painted by one resident continue to be an attractive feature on the walls. Residents all indicated by their words and actions that they felt at home there. There is an accessible garden area for sitting out in good weather. The garage, which has been adapted for storage and to house the washing machine and a tumble dryer and an additional freezer, has been tidied up and is now less ‘cluttered’. There are still some potentially hazardous cleaning materials stored openly in there, limiting potential for residents to use this facility with less supervision. The tumble dryer was not working on the day of the inspection, resulting in some damp clothing drying on radiators. Staff advised that contact had been made to get it fixed. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 18 Residents showed me their bedrooms, which were spacious and furnished and decorated in line with their preferences. One resident has a downstairs bedroom, with a toilet adjacent, to support his mobility needs. The home continues to be clean and tidy, the only odour being from damp washing drying. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents continue to benefit from the attentions of a small, consistent staff team familiar with their needs and wishes. EVIDENCE: In the absence of the manager, staff records were not accessible on this occasion. These had been inspected and found to be satisfactory on a previous inspection, and there is no reason to suppose they continue to be other than satisfactory. Staff continue to support residents in a relaxed, positive manner proportional to their needs. Residents spoke very positively of staff. The staff team continues to be relatively small, and to provide cover and support without reliance on agency workers or others unfamiliar with the residents. Staff spoken to showed a good knowledge of the residents and their needs. The pre-inspection questionnaire advised that 40 of the staff have a National Vocational Qualification, currently just short of the required 50 . The manager advised that this target has now been exceeded. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service continues to promote the health, safety and welfare of residents EVIDENCE: The pre inspection questionnaire completed and returned by the manager stated that all required safety checks are in place, apart from an overdue electrical wiring check, for which the landlord is being pressed. Suitable fire precautions, including fire doors on residents’ rooms, continue to be in place. The closure on one downstairs bedroom door makes it difficult for the resident of that room to open it unaided. Staff agreed that an alarmactivated closure device, similar to those already in place on more communal doors, would enable him to enter his bedroom more independently. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 21 The home was being run satisfactorily in the absence of the manager, with the differing needs of the residents being catered for. Residents continue to be positive in their views concerning the way the home is run. The home currently has three residents. It has one vacancy. Since the conversion of one room to an office/sleep-in room, the home has capacity for just four residents. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 22 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 23 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 RQN Regulation 39 Requirement The home must seek an amendment in its registration, from five to four residents. (this is an outstanding requirement from the previous inspection.) Individual care plans must be sufficiently detailed and regularly reviewed as to usefully reflect the changing needs of residents, and to show how these needs are met. Timescale for action 05/04/07 2. YA6 15 05/04/07 Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 24 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 YA6 YA6 YA20 YA28 YA42 Good Practice Recommendations Individual care plans should not include headings for topics that are not currently relevant to that person. A life story book, or similar, could increasingly benefit one resident in conveying his needs and wishes Brief details of the purpose of medications, and relevant details about their application, where relevant, would assist any staff less familiar with them. COSHH substances in the garage should be stored securely in order to allow more independent access to the rest of the garage. An alarm-activated closure device on the downstairs bedroom door would help make that room more accessible to the current occupant. Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Paks Trust Hatfield House DS0000004455.V324666.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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