Inspection on 20/02/06 for Pelham Grove Residential Home

This inspection was carried out on 20th February 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pelham Grove Residential Home 08/08/05

Pelham Grove Residential Home 07/01/05

Pelham Grove Residential Home 26/08/04

Pelham Grove Residential Home 29/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Pelham Grove Lark Lane Liverpool Merseyside L17 8XD Lead Inspector John McCabe Unannounced Inspection 20th February 2006 09:30 X10015.doc Version 1.40 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 Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Pelham Grove Address Lark Lane Liverpool Merseyside L17 8XD 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) 0151 727 0758 Southern Cross Home Properties Limited Irene Hughes Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 35 Personal Care Beds. Three named persons under 65 years old may be accommodated, within the overall total of 35. The Manager will obtain an NVQ Level 4 qualification in management and care, or the equivalent. 8th August 2005 Date of last inspection Brief Description of the Service: Pelham Grove is a purpose built care home in the Sefton Park area of Liverpool. It is situated off Lark Lane and is very close to various local amenities and public transport. The home provides personal care for 35 Older People over the age of 65 years. The home is staffed twenty-four hours a day and many of the staff have completed their NVQ level 2 Care Award. Most of the accommodation is provided in single bedrooms on two floors. The accommodation on the upper floors can be accessed easily by the passenger lift. Some of the bedroom are large and can be shared on request of the resident e.g. for couples. In addition the home has many aids to promote the safety of the residents such as: grab rails, assisted baths, hoists, and a call system. The home has a dining room and lounge on the ground floor and additional sitting room on the first floor, which is also used as an activity room. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four hours with the registered manager of the home. A full tour of the building was undertaken and included bedrooms, kitchen, laundry and the garden areas. Case tracking was done on the files of both residents and staff, and documents relating to the safety of the home were also inspected. The home was not as clean and tidy as it could be; this was due to one of the domestics having to leave the building because of illness. What the service does well: What has improved since the last inspection? What they could do better: The residents Pre Admission Assessment document, needs to be fully completed, especially for those residents who have cognitive impairment. Specialist care training for staff is required to ensure that the assessed and changing needs of the residents are met. Currently, the home accident book for staff and residents does not comply with the Data Protection Act 1998, better management and administration of the book is required. Care staff must be trained to monitor the affects of head injuries of residents, especially after falls. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 6 Risk assessments should be undertaken to ascertain whether or not residents who have cognitive impairment/dementia, should have soap products in their bedrooms, and their wardrobes secure to the wall so preventing accidents. Corporate management of the home must review the banking arrangement for the resident’s to ensure that accrued interest on their own monies is paid directly to them. 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. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. The Home’s Statement of Purpose is up to date and ensures that the home stays within the category of resident agreed with the commission, and prospective residents have some knowledge of the home before they decide to move in on a permanent basis. Senior care staff in the home are not fully completing the resident’s preadmission assessment documentation. This means that some of the care needs of the resident may not be identified, before being admitted to the home EVIDENCE: All residents in the home are provided with a statement of terms and conditions, plus a contract when they move in to the home on a permanent basis. Residents are able to visit the home or have an overnight stay before they move in on a permanent basis. The home’s senior carers undertake a pre-admission assessment on residents before they are admitted to the home, to ensure care needs are identified. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 9 Other health care professional known to the residents are involved in the assessment However, during the case tracking of a newly admitted resident the pre admission document was observed to not have been fully completed with regard to the cognitive needs of the resident. Residents who experience short term memory loss or possible early stage dementia can be depressed, have changes in perception (hallucinations), thought disorders (delusions) challenging behaviours etc. It is important that a robust pre admission assessment is undertaken especially in circumstances were a prospective resident has cognitive impairment. This will assist in ensuring that the home has the skill mix of staff to meet the assessed and changing care needs of the resident. It is also recommended that the current format for assessing cognitive impairment be revised to ensure the necessary information is secured. This should allow for more informed decision making as a consequence of securing relevant information form social worker’s, CPN’s etc. There was evidence that senior care staff had undertaken training in Dementia care, but there was no evidence that this information had been cascaded to other care staff in the home. Care staff in the home should undertake specialist care training i.e. dementia, cognitive impairment, diabetes, and stroke, which must be ongoing, to help ensure that the assessed and changing care needs of the residents are met. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 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 the following standard(s): 7,8,9,10, Resident’s individual health, personal and social care needs are clearly recorded, and provides care staff the information they need to meet the residents care needs. EVIDENCE: All residents in the home have an individual care plan, which is formulated on admission to the home, and reviewed by the senior carers on a monthly basis. Residents and family also contribute the formulation of the plan. Daily health records are documented for each resident, this also includes any critical incidences plus any visits from GPs, specialist nurses etc. However, all the residents daily health records are not timed, carers must insert a 24-hour clock time each time a written report is entered. Night staff must cease using the Latin term “Nocte” (Night) and record a time when the night report is written. No resident in the home self medicates, all medications for residents are administered by the carers in the home. The protocols for the receipt, storage, Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 11 disposal, and documentation of medications in the home are in accordance with the National Minimum Standards (NMS). Homely remedies for each individual resident should be approved in writing by their GP at least once annually. The home combined resident/staff accident book does not comply with the Data Protection Act 0f 1998. All completed accident forms remain in the book, this means that staff entering details of their accident can refer to other staff and what accidents they have recorded, this is a breach of confidentiality. All accident forms when completed should be filed in the personal file of the resident or staff member. It is also recommended that the policy relating to falls be revisited with the staff group to ensure they are clear as to what action to take in the event of a resident experiencing a fall. No resident in the home has a pressure sore. All residents in the home can access their NHS entitlements, which include dentists, opticians and chiropodists. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 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 the following standard(s): 12,13,14,15. Residents are encouraged to exercise choice and flexibility how they spend their day in the home. They can also pursue leisure and educational activities according to their choice and preferences. This allows independence and individuality for each resident. Residents receive a balanced diet offering variety while reflecting resident’s preferences. EVIDENCE: Residents in the home are asked on admission, about their lifestyle, choice of foods, and choices and preferences of the social activities that they would like to participate in. On admission to the home the resident with help from a family member completes “Getting to know you” questionnaire, which is a “Work life History” of the resident, and includes schooling, work, hobbies, food likes and dislikes etc. This information is used to facilitate organised activities for the resident, carers plan and implement the activities for the residents. When residents participate in organised activities it is recommended that this be recorded in their personal file, how they participated in the activity. This will help to ensure that a “Holistic” overview of the resident’s day is documented in one place. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 13 Visitors are allowed in the home at any reasonable time of day, residents may entertain their visitors, in the communal lounges, or in their own bedroom. During the inspection of the kitchen, no fresh vegetables except potatoes were available. The manager told the inspector the home was expecting a delivery. Residents told the inspector that they enjoyed the variety of food in the home, and were looking forward to lunch of soup and sandwiches. Alternatives are offered at mealtimes and the main meal of the day is served in the evening. Some of the residents prefer to take their meals in their own room rather than go to the dining room. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 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 the following standard(s): 16,17,18. The home has a satisfactory complaints system with evidence that residents feel their views are being listened to and acted upon. The homes policy and training programmes for POVA, and Whistle Blowing, ensure that the homes residents are protected from any abuse. EVIDENCE: There have been no internal complaints, or complaints to the commission since the last inspection. The home has robust complaints procedures, which is documented in the residents guide and the staff handbook. The procedure is also available and on display in the reception area of the home. Many of the residents used their postal vote in the Local Elections. The care home has up to date information on the Protection of Vulnerable Adults (POVA), this information is communicated to new employees on their induction course. There was evidence that many of the staff in the home had undertaken training on POVA protocols, and the Whistle Blowing Policy. The inspector spoke with an experienced care worker who had just been employed in the home was unsure what the Whistle Blowing Policy really meant. The registered manager should ensure that all staff are aware of and understand this policy as it is an important aspect of ensuring residents are safeguarded. This is particularly relevant should there be a situation when a staff member does not feel able to take up concerns directly with a manager. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 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 the following standard(s): 19,20,21,22,23,24,25,26. The standard of decor within this home is good, with evidence of the need for continuing improvements, through maintenance and planning. The home does present as a homely and comfortable environment for the residents. EVIDENCE: The home is well maintained and decorated, suitable for its stated purpose, though some of the resident’s bedrooms smelled of urine. There are grab rails throughout the house and ramps for wheelchair access. Some of the kitchen cupboard shelves need cleaning to help ensure high standards of hygiene. During the inspection of the laundry, it was observed that many of the resident’s hand towels were torn, tattered and threadbare, no use for purpose. The manager instructed the laundry lady to dispose of the towels immediately. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 16 The communal lounge, dining room is furnished in a homely way, with domestic lighting, which is inadequate for the purpose, television and radio, library books. The upstairs lounge is much brighter in appearance. The manager told the inspector that the ground floor was to be redecorated, a new carpet fitted and new lighting. The front gardens are well cared for and tended and offer seating for the service users, the rear and side gardens space needs to be tidied up of accumulated rubbish. The communal bathrooms need to be repainted, tiles grouted, and some of the floor covering need to be replaced. Most of the residents have personalised their own bedrooms with photographs and memorabilia. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The standard of vetting and recruitment practices has improved with the appropriate checks being carried out on all new staff. This helps ensures that the residents are not potentially put at risk. EVIDENCE: The home recruitment policy is robust and in accordance with the National Minimum Standards (NMS). All staff in the home have an up to date CRB/POVA enhanced certificate, or a POVA First certificate before being allowed to work in the home, so ensuring the safety of the residents. The inspector reminded the manager that, an experienced senior care worker must mentor new employees who are employed on the basis of a POVA First Certificate, unit their full-enhanced CRB certificate was obtained. The home must commence induction training for newly employed staff; the training should be documented and signed by the trainer and trainee. Currently there are vacancies for a kitchen assistant (16 hours) and a carer for (22 hours) Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 18 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. Staff morale in the care home is good, resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. However, the registered manager must exercise appropriate control over the safety of the home, especially concerning electricity and gas supply safety certificates EVIDENCE: The manager of the home has over twenty (20) years care home experience. She is registered with the commission and will commence NVQ Level 4 in Home Care Management in March 06. The leadership of the home is open and transparent; both staff residents/relatives have meetings that are minuted and actioned upon. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 19 All care staff have documented supervision. Documented supervision can help ensure that all staff have the opportunity to discuss with the manager, and other senior carers, any issues, which can effect or improve the care for the residents. Documented supervision of all staff also gives the staff the opportunity to discuss their own /or identified training needs. The banking arrangements for the residents was reviewed, currently the home is holding a bank account of £35,000 belonging to various residents. The interest from this account is transferred to another bank account; (£1200) this money is then used for the resident’s activities. There is no evidence to say that the residents agree to this, one resident has £9000 in the account, it would appear that he has not been consulted on how the interest on his money is used. Where possible the residents must be in receipt of their accrued interest. Residents should be offered services of an advocate, in the case of residents who don’t verbally communicate a “Signer” should be appointed to get their views about their monies. The homes N.I.C.E.I.C. Certificate for electricity supply and safety is dated 2002. The certificate clearly states Unsatisfactory. There is some evidence that electrical repairs have been undertaken in the home, but there is no evidence to suggest that all the failings in the report have been rectified. Therefore, it is essential that a further N.I.C.E.I.C. certification be urgently carried out to help ensure the safety of the home. The certificate of worthiness for the home gas supply and appliances is also out of date and needs renewing. The certificates of worthiness and insurance were available for hoists, lift, and fire appliances. The homes fire drill book was up to date and contained the signatures of staff that had participated in the drill. Personal files of both staff and residents are kept secure in accordance with the Data Protection Act 1998, thus maintaining confidentiality. The Employers Liability Insurance Certificate is in date and valid. Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 20 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 2 3 3 2 Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14 Requirement The registered person must ensure that a comprehensive pre admission assessment is undertaken on all residents before they are admitted to the home, especially those residents with cognitive impairment. The registered person must ensure that care staff are given specialist care training to help ensure that the assessed and changing care needs of the residents are met. The registered person must ensure that the homes accident book is properly maintained The registered person must ensure that the residents GP confirms in writing at least once a year, the Homely Remedies the resident is allowed. The registered person must ensure that the communal bathrooms in the home are redecorated, repainted. The registered person must ensure that the side and rear garden of the home are cleared of rubbish. DS0000025190.V282306.R02.S.doc Timescale for action 31/03/06 2 OP4 19 31/03/06 3 4 OP8 OP9 17 13 31/03/06 31/03/06 5 OP19 23 30/04/06 6 OP19 23 31/03/06 Pelham Grove Version 5.1 Page 22 7 OP21 16 8 OP24 12 9 OP24 12 10 OP35 20 11 OP38 23 12 OP38 23 The registered person must ensure that torn and tattered hand towels are not supplied to residents in the home. The registered person must ensure that, those residents with cognitive impairment are risk assessed to determine whether their freestanding wardrobes in their rooms should be secured to the wall. So preventing accidents. The registered person must ensure that those residents with cognitive impairment are risk assessed to determine whether they can be allowed liquid soaps, shampoos etc in their room. So help avoiding any accidental ingestion of the harmful liquids. The registered person must ensure that monies belonging to residents are put in their own bank account, and they receive the accrued interest from that account. The registered person must ensure that the homes N.I.C.E.I.C electricity certificate is reviewed and homes electrical installations are checked. The renewed certificate or, evidence the homes electricity installations are safe must be forwarded to the Liverpool/Wirral office CSCI. The registered person must ensure that the certificate for the gas installations in the home is up dated and valid. A copy of this document must be forwarded to the Liverpool/Wirral office CSCI. 31/03/06 31/03/06 31/03/06 31/03/06 28/02/06 28/02/06 Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 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. Refer to Standard OP3 Good Practice Recommendations It is recommended that the current format for preadmission assessment be revised to ensure the necessary information is secured for prospective residents whom may experience cognitive impairment. When residents participate in organised activities it is recommended that this be recorded in their personal file, how they participated in the activity. This will help to ensure that a “Holistic” overview of the resident’s day is documented in one place. The registered person should ensure that the policy for observing residents with head injuries is reviewed and up dated, and staff given clear instructions as to their actions when a resident has a head injury. The registered person when undertaking Induction training Course should ensure that the signatures of the trainer and trainee should be recorded to evidence the training has taken place. The registered manager should ensure all staff are fully aware of and can demonstrate an understanding of the ‘Whistle Blowing ‘ policy. 2. OP12 3. OP8 4. OP30 5. OP18 Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Pelham Grove DS0000025190.V282306.R02.S.doc Version 5.1 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. 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