Inspection on 11/04/05 for Partridge House Nursing And Residential Care Home

This inspection was carried out on 11th April 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

Partridge House Nursing And... 01/05/07

Partridge House Nursing And... 26/05/06

Partridge House Nursing And... 09/02/06

Partridge House Nursing And... 03/11/05

Partridge House Nursing And... 02/08/05

Partridge House Nursing And... 11/01/05

Partridge House Nursing And... 24/08/04

Partridge House Nursing And... 04/06/04

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

CARE HOMES FOR OLDER PEOPLE Partridge House Leybourne Road off Heath Hill Bevendean Brighton BN2 4LS Lead Inspector Elizabeth Dudley Unannounced 11 April 2005 9:30 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. Partridge House Version 1.10 Page 3 SERVICE INFORMATION Name of service Partidge House Nursing & Residential Care Home Address Leybourne Road off Heath Hill Bevendean Brighton BN2 4LS 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) Anchor Trust 01273 693332 Vacant Care Home with Nursing 38 Category(ies) of Mental disorder, (38), Dementia (DE) (38) registration, with number of places Partridge House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is (38) 2. Service users should be aged 60 years or over on admission Date of last inspection 11 January 2005 Brief Description of the Service: Partridge House is a purpose built home that was developed in partnership between Anchor Trust, ARDIS and Brighton and Hove Social Services to provide care for 24 older service users with mental health problems. Fourteen new rooms were recently added bringing the number of service users able to be accomodated to 38. This will provide 30 nursing beds, 6 for residential care and 2 for respite care. A new conservatory has recently been added to the building.All of the accomodation provided is in single rooms which have ensuite facilities and the home is divided into four units The gardens are well maintained accessible to all service users, a shaft lift gives access to all parts of the building. Anchor Trust is a not for profit organisation and ARDIS is a local charity providing services for people with dementia. Partridge House is situated in a residential area, local transport links are poor, but there are good car parking facilities. Partridge House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 11th April 2005 over a period of 8 hours, and is part of the yearly inspection programme for this home. During this period 20 residents, 8 visitors and 10 staff including 3 registered nurses were spoken with. A tour of all parts of the home and discussion took place with the acting manager, Ms Sue Helliwell. Staff and residents records, menus, office files, training records and documentation relating to health and safety were examined. The home has been without a Manager since January 2005, and prior to that had been without a manager for 8 months. During the past few months the CSCI has made visits to the home to monitor some of the requirements that had been previously made. The majority of these requirements have now been met and there has been much improvement made within the home. There had been several complaints received by CSCI during the past year and these have been dealt with by the home and CSCI, but during the year several staff have left. This therefore makes it difficult for the home to maintain policies and to advance staff training. However staff numbers have been maintained by the use of agency staff and these are all staff that come to the home on a regular basis, therefore they are familiar with the residents. The home is presently taking measures to recruit more permanent staff. What the service does well: Partridge House specialises in the care of older residents with a mental health illness, often related to the elderly. The qualified nurses are specialised in mental health needs and the care assistants receive training related to the mental health needs of the older person, therefore the home offers highly qualified care to those older persons with these needs. The home provides a knowledgeable, understanding atmosphere, and allows residents to live their lives with dignity whilst using as little medication as possible. Residents are allowed to express themselves and have freedom to walk around the home and into the gardens as they wish. Two visitors spoken to described the home as ‘ a wonderful place’ and one visitor said that the staff had given her support and helped her to come to Partridge House Version 1.10 Page 6 terms with her husband’s illness. All other visitors (6) spoken with praised the home and the kindness of the staff. What has improved since the last inspection? What they could do better: The home needs to provide an activity co-ordinator who will provide a selection of leisure activities suitable to the needs of the residents, including outings. The registered nurses must practise a safer method of ensuring that they sign for all the medicines they give, that these are correctly labelled and given at the correct time. They must also make sure that they are very strict about themselves and care staff maintain good practice in infection control. Partridge House Version 1.10 Page 7 Residents plans of care should be reviewed on a monthly basis and there should be a signature of the resident or their relative, where able, to show that they know what care they will be receiving. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Partridge House Version 1.10 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 Partridge House Version 1.10 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) 1,2,3,4,5. Partridge house provides prospective residents and residents with the information to enable them to decide whether it is the right home for them. However it has been slow to provide residents with their terms and conditions of residence. Although residents mental health needs can be met, there are some limitations in the meeting of physical health needs. EVIDENCE: The statement of purpose and the service users guide contain all the information to enable a resident or their relative to decide whether this is the right choice of home. These are written in a fairly clear manner and the acting manager states that all residents have a copy of the ‘service users guide.’ However the home has not yet provided all residents with a statement of terms and conditions, and the home had been previously required to do this and keep evidence that all residents have a copy of this document. All prospective residents are assessed before they are admitted, either by the acting manager or by a registered nurse. The home can meet the assessed mental health needs of the residents, but there are some areas of the physical Partridge House Version 1.10 Page 10 needs that they are unable meet. They should refrain from admitting further residents with these needs (identified in standard 8) until all registered nurses have further training in these. Partridge House Version 1.10 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The staff at Partridge house are well able to meet the pyschological health and the majority of physical health care needs of the residents.As the majority of registered nurses are registered in the mental health field, the physical needs of some residents require general nursing knowledge and this should be gained from specialist nurses. There is some concern around the storage and administration of medication which the acting manager is aware of . Residents appear well cared for. EVIDENCE: All residents have a plan of care which shows the care to be given with reference to their psychological, physical and social needs. Although standard 7 states that care plans must be reviewed and updated at least on a monthly basis, this has been taking place between 2 –4 monthly in many of the care plans. The staff should be aware that all parts of the plan, including the waterlow score and skin integrity needs reviewing monthly. This has been discussed on previous inspections.There was no evidence that residents had been involved in the formation or reviewing of their care plans. Partridge House Version 1.10 Page 12 There were no risk assessments for those residents who use wheelchair lap straps and these must be included, this was discussed on a previous inspection. One of the residents has some pressure damage which has not been assessed by the community wound care nurse specialist and some wound care plans did not show when the treatment was finished. The wound care nurse must be contacted in all instances of pressure damage. Some of the registered nurses are not able to catheterise men and this has led to this being left until late in the evening when they received attention, and the ‘Older persons specialist nurses’ being called in to do this. The acting manager must ensure that all registered nurses have received updating on this and can meet the physical needs of any service users admitted to the home. Likewise the home was seen to be using multi use night bags for one resident. Although this had been washed out it was left without a cap on. The registered nurses are reminded that single use night bags only should be used in a communal situation. The controlled drug cupboard contained Temazepam tablets which had no name on them to indicate which resident they belonged to, and paracetemol suppositories were being stored in temperatures above 25 C. There was an indication that Lorazepam had been given in the morning instead of night time, without any rationale or prescription change noted, and this being dealt with by the manager. Some medications were not signed for on administration. Staff must be aware of the dangers of forgetting to sign for medication. All medical, nursing and chiropody treatment is given within residents own rooms, and staff were seen to knock on room doors before entering and to treat residents with respect whilst making every effort to uphold their dignity. All residents appeared clean and well cared for, and 6 relatives spoken with stated that they admired the way that the staff dealt with the residents, and that the residents always looked well cared for and happy when they visited. They also stated that they felt the dignity of the residents was upheld and that as far as possible residents choices regarding their lifestyle were met.Two visitors stated ‘Its wonderful here’. Partridge House Version 1.10 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 There are no specialist activities provided for residents at present and these are important for residents of this category.Menu choice is available and the menus and type of food offered has improved, but residents are not aware of choices available and staff should make the residents preferences known to the catering staff. EVIDENCE: Residents are able to have some choices in their times of getting up an going to bed, and those residents able to discuss this felt that their choices were being met. However previous inspections have shown the need for a regular person to provide activities for the residents which would be in keeping with their needs. The care assistants do some entertainment and some activities and two care assistants have attended courses in activities for residents with mental health problems, but this is difficult to combine with the ongoing caring for the health needs of the residents. The acting manager states that they are still recruiting for an activities organiser. Residents can spend time in the garden and some activities are provided. Registered nurses spoke of the need to take residents out for trips and one relative stated that all she wished for was to take her mother into Brighton for ‘one last time’- the home state they are trying to arrange this. Partridge House Version 1.10 Page 14 Friends and relatives can visit the home at any time of day and 8 visitors were spoken with, all said they are made to feel very welcome and involved, and that the staff are very supportive. They stated that the home contacts them immediately if necessary. Ministers of the local churches visit the home and there is a voluntary support group arranged in fund raising for amenities for residents. There is a new varied menu and this includes fresh vegetables and fruit. Although in the past there have been concerns about the type of menu available and the availability of food, this appears to be improving. One resident who has made complaints about the food in the past, also feels that this is improving and said she was happy with the food at present. However a visitor stated that sometimes the home ‘cuts corners and provides the basics only’ and that this resident who should have a soft diet, does not always get it and is hungry at times. Most cakes are made on the premises but there was evidence that some cakes and puddings are being brought in and frozen. There was evidence that choices of menu are available but whether residents were made aware of the choices was not evident. One resident was given Spaghetti Bolognese, stated she hated it and had rice pudding substituted. The cook said she had not been made aware of the residents’ likes and dislikes. More thought needs to be given regarding making residents aware of the choices at all three meals and using knowledge from the care plan were residents are unable to make the choice. Partridge House Version 1.10 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 There is no complaints policy on the notice board this must be replaced so that visitors to the home are aware of how to make a complaint. In some instances complaints were taking a long time to be dealt with and there has been an instance where complaints have not been taken forward to the relevant authority. Management now seems aware of the importance of addressing all complaints within given timescales and acting upon these. EVIDENCE: The home has had 6 complaints during the past 12 months and these have resulted in some POVA recommendations being made. The home has a complaints policy in the service users guide and a copy of this used to be on the main notice board, but this is missing at present. The acting manager is aware and will replace it. Some visitors were not aware of how to make a complaint but residents who were able to understand this were aware that they could go to the manager. Not all complaints have been dealt with within an acceptable timescale and the CSCI is aware and has acted on this. Likewise Anchor management has been involved in addressing these complaints. A confidential complaints file is now kept. Staff spoken with identified that they have received recent training on the protection of the vulnerable adult and were aware of the issues that indicate abuse. Partridge House Version 1.10 Page 16 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 standards of tidiness and cleanliness within the home have improved significantly. The home now provides a pleasant homely environment for residents. EVIDENCE: The home was clean and tidy on the day of the inspection and many of the minor maintenance issues previously identified have been addressed and the home now employs a maintence person. The majority of the resident’s rooms were odour free, but two rooms that were odorous were identified to the manager. All rooms have door locks and lockable facilities. Most residents have brought in their own possessions to personalise their rooms. Some curtains have been pulled off their tracks and the valances hanging off, but the manager stated that they have realised that another style of curtain would be better for the residents to deal with and have arranged for advice. Partridge House Version 1.10 Page 17 Some of the chairs in the lounges will need replacing as will the lounge carpets. The window restrictor in the first floor lounge was seen be overridden by a care assistant and this was not able to be replaced. The manager was asked to attend to this as a matter of urgency and to remind carers not to override these. The garden is well maintained and is accessible to all residents and visitors. Records of water temperatures were seen and were within the recommended ranges. The home has been assessed as providing a suitable environment for residents with physical and mental health needs, and there are sufficient bathrooms and toilets for the needs of the residents. All rooms have ensuite facilities, consiting of wc, washbasin and assisted shower. The majority of staff were seen to be following infection control procedures and to be aware of the home’s policies, however multi use night bags were being used for one catheterised resident. This has been discussed. Gloves and aprons were available for care duties and staff were wearing these. The majority of staff are now in possession of their food handler/hygiene courses. Partridge House Version 1.10 Page 18 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) 27,29,30 The recruitment practices within the home now meet the regulations and therefore ensures the safety of the residents. Staff now receive regular updating on physical health needs relating to the older person. Although there is still need for further recruitment of permanent staff, the home ensures that there are sufficient staff on duty to meet the needs of the residents, EVIDENCE: The home is still lacking sufficient permanent staff and continues recruiting, staff numbers being made up by agency staff who are regular to the home and know the residents. All documentation including CRB checks were present in staff files and there was evidence that no member of staff had commenced employment without a POVA check. All new staff receive induction training in line with the National training organisation’s induction course. Staff are receiving ongoing training in the needs of the older person, as well as further training pertinent to mental health needs. Partridge House Version 1.10 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) 31,33,34,35,36,37,38 The home tries to ensure the ongoing safety of the residents and staff, however a fire risk assessment and fire training for staff is overdue. The policies of the home in dealing with residents money and health and safety show that this is mostly being met . EVIDENCE: The home has had some changes in management in the past few years and is in the process of recruiting a new manager, meanwhile Ms S Helliwell the deputy manager is managing the home. During this time formal supervision of staff has been neglected, due to other matters taking precedence and this will be recommenced. Registered provider visits and quality monitoring still take place. Partridge House Version 1.10 Page 20 There was evidence to show that the home has good procedures in place to deal with residents money, any money held by residents are kept in a bank account and records kept of expenditure. During the tour of the home, a care assistant was seen to override the window restrictor in the first floor lounge and was unable to replace this. Although this was identified in Standard 23, it poses the question of whether other window restrictors would be easily displaced and therefore Anchor homes should address this as a priority. Whilst examining the certificates and service agreements for utilities and equipment necessary to ensure the safety of residents and staff within the home it was noted that the fire risk assessment of the premises is due to be updated as are the electrical wiring certificate and lift certificate. The CSCI must be notified when these have taken place. If any residents have their room doors left open then appropriate closing devices must be put in place to reduce fire risk.There has been some difficulty in arranging fire training for staff and this has now been arranged for the 11th May 2005. Although the home has complied with a requirement made to put a lock on the staff changing room door, this has been in the form of a bolt place just above the door handle, which would enable any resident to open this. This must be reconsidered and an alternative lock provided. Likewise the kitchenettes also have bolts on the corridor side, but these are not being used by staff, therefore allowing residents to wander in there unobserved, alternative methods should be used for this. Staff have already requested a key pad on one kitchenette door and this has been done. This could be considered for the other doors All staff have attended moving and handling training and have knowledge of the control of substances hazardous to health (COSHH). They have also attended first aid training and food hygiene training is ongoing. The manager should ensure that there are risk assessments applicable to all parts of the home and any special needs of the residents in both the home files and in the care plans. Partridge House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 1 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 1 x 3 3 3 1 2 2 Partridge House Version 1.10 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 9 Regulation Reg 5(b) Requirement That all service user is provided with a copy of the terms and conditions. This was a previous reuirement to be completed by the 11th Feb 2005 That a person is employed by the home to provide suitable activities for this service user group. This was a previous requirement to be completed by 1st Feb.2005 That a lock which cannot be accessed by service users is affixed to the staff changing room door. All medications to be stored correctly and staff to be aware of the NMC guidelines relating to medication especially to those treated as a controlled drug. This was a previous requirement Feb 1st 2005 That efforts be continued to recruit permanent staff That the window restrictors are checked and staff refrain from overriding them. That the corridor doors to kitchenettes and the staff changing room are provided with Version 1.10 Timescale for action May 5th 2005 2. 12 Reg 16(m) (n) July 1st 2005 3. 38 Reg 13(4) July 1st 2005 Immediate 4. 9 Reg 13(2) 5. 6. 7. 26 38 38 Reg 18(1)(2) Reg 13(4) Reg 13(4) Immediate and continuing May 5th 2005 May 5th 2005 Partridge House Page 23 8. 36 Reg 18(2) 9. 7 Reg 15 (1)(2)(b)( c) 10. 38 Reg 13(4) 11. 8 reg 13(1)(b) Reg 14(1)(d) 12. 3 &4 13. 26 Reg 13(3) locks inaccessible to service users That formal supervision of staff takes place at intervals identified in the National Minimum Standard That all care plans shall show evidence that the service user or their relative has been involved in the plan of care and all parts of the care plan are reviewed on a monthly basis That risk assessments for lapstraps and other restraints are kept in the service users care plan. That the advice of specialist nurses are sought where applicable( ie service users with pressure damage) That service users are not admitted to the home unless their needs can be met and where required additional training given to staff to meet these needs. That single use only catheter bags are used to reduce infection May 5th May 5th and continuing Immediate Immediate Immediate Immediate 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 16 2 Good Practice Recommendations That a copy of the complaints procedure is displayed in a prominent postion within the home. That evidence that service users have been given a statement of terms and conditions is provided in service users office files Partridge House Version 1.10 Page 24 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Partridge House Version 1.10 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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