Inspection on 16/02/06 for Penlea

This inspection was carried out on 16th 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 found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Penlea 16/07/08

Penlea 27/07/07

Penlea 17/08/06

Penlea 10/08/05

Penlea 11/01/05

Penlea 27/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Penlea 13 Dunheved Road Launceston Cornwall PL15 9JE Lead Inspector Ian Wright Announced Inspection 16th February 2006 14:45 Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Penlea Address 13 Dunheved Road Launceston Cornwall PL15 9JE 01566 775943 01566 775943 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) H4037@mencap.org.uk Royal Mencap Society Mrs Lesley Aston Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: Mencap provides care for up to 8 adults with learning disabilities at Penlea. The home is situated in Launceston within walking distance of the town centre. Mencap also operates several care homes in Cornwall. The registered manager is Mrs L. Aston. All service users have their own bedrooms and there is a pleasant lounge and dining room for service users use. Access to the home and its ground floor is wheel chair accessible. Penlea has a pleasant front garden, and a patio at the rear which service users can use. Seating in the garden is provided. There is satisfactory parking at the front and rear of the home. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over six hours. The inspection was carried out on an announced basis. The inspector was able to speak to the majority of service users, the registered manager and the staff members on duty. The inspector examined care and service records, and inspected the building. What the service does well: What has improved since the last inspection? What they could do better: This inspection produced a total of eight statutory requirements, which the registered persons must address. Care plans need to be reviewed more regularly. This will help ensure it is clear what support service users require, and assist the process of ensuring care is provided consistently. Currently staff look after the majority of service users moneys. However service users hold the key for their cash boxes and sign for any personal financial accounts. Arrangements regarding the management of service user finances must be risk assessed and regularly reviewed, with the objective of increasing service user independence where this is appropriate. Medication training needs to be improved by Mencap, for example to ascertain staff competence in administering medication. Although most staff have received some training, all staff that administer medication must receive satisfactory formal training. Care needs to be taken to reduce errors when medication is administered and all staff may require further guidance. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 6 Mencap needs to review its complaints procedure. Contact details for the Commission for Social Care Inspection need to be made available to individual service users. Service users need to be aware they can contact the Commission, at any stage, when they have a complaint. The current procedure implies the Commission should only be contacted as a last resort if someone has a complaint. Training needs some improvement. For example there are some gaps in training required by law. All staff should have training in fire, manual handling, first aid, food handling and infection control. Additional training specific to the needs of service users at Penlea is also required; i.e. training in autism awareness and training to care for people with epilepsy (e.g. how to care for a service user who has had a seizure). Although most staff have received this training-some staff have not, and this needs to be addressed as soon as possible. For example if staff do not have training regarding epilepsy this could put service users at risk. Although health and safety precautions are generally satisfactory, precautions need to be taken to prevent staff and service users from the risk of Legionella in line with Mencap’s policy. 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. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 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 Penlea DS0000009213.V274804.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 The registered provider supplies suitable information to assist service users and their representatives, to make an informed choice regarding moving to the home. Suitable links are maintained between staff and other external professionals so service user needs are met. EVIDENCE: A suitable statement of purpose, and service user guide were inspected. The manager said the service user guide is issued to service users, and where appropriate their next of kin / representative. The registered manager said the staff team have developed suitable links with external professionals such as community nurses, general practitioners, chiropodists, dentists and social workers. The manager said staff have access to comprehensive training provided by Mencap, for example to National Vocational Qualifications. The registered manager said currently four staff have at least a NVQ 2 in care. Two staff have just been registered to complete a NVQ 2. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Appropriate policies and procedures, and documentation are in place regarding care planning and risk assessment. However care plans must be reviewed and updated regularly. Documentation is stored confidentially. Service users receive support to develop their skills and take appropriate risks. Service users are consulted about major and day-to-day decisions. EVIDENCE: A copy of a care plan is contained in each service user’s file. Service users have at least an annual review meeting. Some reviews were held in November 2005. Members of service user families, and other professionals involved in the users’ care were invited. Care plans do require updating for example the two care plans inspected appear to be last reviewed and updated in 2004. This task needs to be completed more frequently. Service users stated they are enabled to make decisions e.g. regarding day activities and major life events. Service users said there are regular residents meetings, which enable them to make comments about life in the home. Minutes are kept of these meetings. The registered manager said there are currently no advocacy services involved with service users. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 10 Service users said they are encouraged to take appropriate risks e.g. go out on their own. Suitable risk assessments are maintained on each service user’s file, and these are reviewed. The majority of service users have their moneys looked after by staff, and information regarding this is documented with financial records. Service users sign for their own government benefits, and bank/ building society accounts. Records for service user moneys were inspected and were satisfactory. Receipts are obtained for expenditure where service users lack the capacity to make decisions regarding how moneys are spent. Risk assessments need to be developed for individual service users regarding the control and management of individual service user moneys. For example the Mencap service user risk assessment procedure could be used. Risk assessments must be regularly reviewed. All information is stored confidentially in the office. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 16, 17 Service users are encouraged to develop their skills and abilities. Service users have suitable opportunities to be part of the local community and have a range of day activities. Arrangements for meals is to a good standard. EVIDENCE: The registered manager said service users are encouraged to develop their skills to be as independent as possible. For example service users are encouraged to participate in household tasks such as cooking and shopping. Service users can participate in religious services if they wish. Two service users currently go to church or chapel. Service users said they are given suitable opportunities to participate in the community for example local events, and using local facilities such as leisure centres, pubs and clubs. Service users have opportunity to have paid jobs, work placements and attend further education. All service users have comprehensive day activity plans. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 12 Daily routines are flexible and tailored according to individual needs. Independence and choices are encouraged. Service users stated they felt very much at home and are well supported by staff. The registered manager said service users receive varying degrees of support to prepare their breakfast and lunch. Service users take turns assisting staff to cook the evening meal. There are currently no service users who have special diets due to health, cultural or religious needs. The inspector shared a meal with service users, which was to a good standard. Staff also ate with service users and everybody discussed what had happened during the day. The meal was unrushed and relaxed, and service users received appropriate support where this was required. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21 Arrangements regarding the management of service users medication is generally satisfactory. However care needs to be taken to reduce the number of administration errors. Management need to ensure staff receive appropriate supervision and training, as necessary, regarding the handling of medication. There is a suitable policy regarding ageing, illness and death of service users. EVIDENCE: The registered provider has a suitable policy regarding the storage and handling of medication. The medication system was inspected. Storage and records of medication is generally satisfactory. However, since July 2005, there were at least five errors reported on incident reports regarding the administration of medication e.g. medication dosages being missed or medication being given to the wrong person. Although the incidents have been dealt with appropriately for example ringing medical services for advice, and reporting the matter, more care should be taken to improve practice. There was no evidence that at least two staff have formal medication training, although both staff only commenced employment in October and December 2005. Formal training should be completed, at the very latest, by the end of the sixth month after commencement of employment. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 14 In regard to the medication training offered, coverage of issues of administration and record keeping is basic. There also is no practical assessment of staff skills after completion of the course to verify staff competence. Mencap must address these matters. The registered provider has developed a policy regarding ageing, illness, death and dying. Although basic, this is satisfactory. Care plans and practices need to demonstrate how the registered persons will meet the changing needs of service users-when this is applicable- as they get older and/ or become unwell. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The registered provider must review its complaints procedure so it meets the national minimum standard and gives service users appropriate information. The registered provider has a suitable adult protection policy, which is effectively implemented. EVIDENCE: The registered provider has developed a complaints procedure. The registered manager has included a summary of this in the service user guide. Information regarding the complaints system has been issued to service users. For example service users receive a prepaid postcard, which they can send to the organisation if they have a concern or a complaint. The complaints procedure is regularly discussed in residents meetings. The inspector read the organisation’s complaints policy in the ‘Operations Manual.’ This requires updating, for example the organisational policy refers to the National Care Standards Commission, which has now been superseded by the Commission for Social Care Inspection. The policy also regards complainants right to contact the Commission as the last stage of the procedure, rather than stating complainants can contact the Commission at any time as outlined in NMS 22.3. Mencap has an appropriate adult protection policy. Most staff have attended Mencap training regarding abuse (Protect Me). The ‘Protect Me’ training is mandatory for all staff as part of the organisation’s induction and foundation training. All staff have a Criminal Records Bureau (CRB) check and (where applicable) a Protection of Vulnerable Adults (POVA) check. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Penlea is a suitable environment for service users living there. The home was clean and hygienic on the day of the inspection. EVIDENCE: The building was inspected. The home offers a pleasant and homely environment for service users. Bedrooms and communal areas are of suitable size to meet the needs of service users. The home was clean and hygienic on the day of the inspection. Suitable cleaning routines are in place. The kitchen units are beginning to look shabby and will need to be replaced in the next few years. It is recommended the housing association make provision for this in their development plan. This recommendation is repeated as the home will shortly be transferred from New Era Housing Association to West Country Housing Association, and they need to be aware of the issue. Should the condition of the kitchen units deteriorate, their replacement will become a statutory requirement. Service user bedrooms are pleasantly decorated according to individual tastes. Furnishings in bedrooms are appropriate. There is a walk in shower on the ground floor, which can be used for people with a physical disability. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 Suitable numbers of staff are employed to support service users. Information required by regulation is obtained regarding the employment of staff. This helps ensure service users are in safe hands. Training needs to improve so staff receive training to satisfactorily meet service user needs, and to adhere to legal requirements. EVIDENCE: Rotas indicate the registered persons provide appropriate staffing to meet service users needs. Service users stated they believed staffing levels to be satisfactory. There are usually two staff on duty between 1500 and 2100 during the week. At weekends there are two staff on duty during the day until 2000. This level of cover is appropriate considering the number and current needs of the service users living at Penlea. The inspector observed information kept on staff files. The registered persons obtain suitable information regarding the recruitment of staff. This includes two references, evidence confirming the person’s identity. Evidence staff have received a Criminal Records Bureau (CRB) check and (where applicable) a Protection of Vulnerable Adults (POVA) check is also obtained. Mencap has a suitable training programme including induction and foundation training, and other training required by regulation. There are however some gaps in training received as required by regulation. This includes fire training Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 18 (for two staff recruited since October 2005) and infection control (for at least three staff). Training records show some staff have received training required by regulation but there are no certificates to evidence this (e.g. one member of staff apparently has attended manual handling, first aid and infection control training although there are no certificates of attendance on their file). If possible the registered manager should try and get duplicate certificates of the courses attended. Some staff need to have training in epilepsy and autism. Staff need to have this training during their induction / foundation period with refresher training as appropriate. Lack of staff training in epilepsy could put service users at risk. The need for some staff to have medication training is detailed earlier in the report. Mencap may wish to consider delivering some of the above training at an area/ regional level as there is also a need for this training at other Mencap homes e.g. in Cornwall. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 40, 41, 42, 43, The registered manager is a suitably competent person to manage the home. Records, policies and procedures are generally satisfactory to help ensure service users receive a quality service. However some policies require updating. Health and safety precautions are generally satisfactory, although measures must be taken to prevent Legionella. According to financial records Penlea is a financially viable care home. EVIDENCE: A job share arrangement for the registered manager’s post has been agreed with the Commission for Social Care Inspection. The current registered manager Mrs Aston will work part time. The other job share post is currently being advertised. The registered provider needs to inform the Commission once the appointment has been made, and an application for registration will need to be submitted soon after i.e. at the very latest when the person starts the post. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 20 A copy of Mencap’s ‘Operations Manual’ was inspected. This is comprehensive, although some policies need to be updated, for example, as outlined elsewhere in this report. Records kept were inspected and found to be satisfactory. Mencap has a suitable health and safety policy. Suitable procedures are in place to test gas and electrical equipment, and there is satisfactory evidence that testing is completed. For example portable appliance testing was completed in May 2005, and gas appliances were tested in June 2005. Mencap has a suitable system of accident / incident reporting. All accidents / incidents appear to have been dealt with appropriately. Mencap has a comprehensive policy regarding the prevention of Legionella. Checks were satisfactory until May 2004, and then records of testing appear to stop. Testing must be completed-preferably according to the organisational policy. Fire testing is generally satisfactory. For example emergency lighting was last tested on 7th February 2006. However testing of the call points of the fire system has been erratic, for example these were only tested twice in January, and must be tested weekly in line with the requirements of the fire authority. Call points were last tested on 7th February 2006. The registered provider keeps suitable financial records that demonstrate Penlea is financially viable. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 3 3 X X X 3 2 3 Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA6 YA9YA7 Regulation 15 12, 17 Requirement All care plans must be reviewed and updated regularly. Risk assessments must be developed for individual service users regarding the control and management of individual service user moneys. These must be regularly reviewed. Care needs to be taken to reduce the number of administration errors and ensure all staff receive appropriate supervision and training regarding the handling of medication The registered provider must review its medication training. Coverage of issues such as administration and record keeping should be improved. There should be a practical assessment, by a suitably qualified person, of staff skills after completion of the course to verify staff competence. The registered provider must update its complaints procedure to state complaints can be referred to the CSCI at any stage should the complainant wish to do so. Details regarding DS0000009213.V274804.R01.S.doc Timescale for action 01/04/06 01/04/06 3 YA20 13 01/04/06 4 YA20 7, 12, 13, 19 01/09/06 5 YA22 22 01/09/06 Penlea Version 5.1 Page 23 6 YA42YA35 contacting the CSCI must be provided. 12, 13, 18 The registered manager must 01/06/06 ensure staff receive training required by regulation. This must include fire training, manual handling, food handling, first aid and infection control. There must be suitable evidence of this e.g. copies of certificates of attendance. 12, 13, 18 The registered provider must provide all staff with training in epilepsy and autism, and ensure this is updated as appropriate. 13, 23 The registered provider must ensure appropriate precautions are taken regarding the prevention of Legionella for example in line with its organisational policy. 01/06/06 7 YA42YA35 8 YA42 01/04/06 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 YA24 Good Practice Recommendations The housing association should make provision in its development plan for the provision of a new kitchen within the next three years. Penlea DS0000009213.V274804.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Penlea DS0000009213.V274804.R01.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. 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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