Inspection on 06/07/06 for Penmeneth House

This inspection was carried out on 6th July 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

Penmeneth House 27/06/08

Penmeneth House 04/07/07

Penmeneth House 20/10/05

Penmeneth House 19/05/05

Penmeneth House 07/10/04

Penmeneth House 15/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Penmeneth House 16 Penpol Avenue Hayle Cornwall TR27 4NQ Lead Inspector Ian Wright Key Unannounced Inspection 11:00 6th and 7th July 2006 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 Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Penmeneth House Address 16 Penpol Avenue Hayle Cornwall TR27 4NQ 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) 01736 752359 Mr Philip John Richards Mrs Felicity Ann Richards Care Home 14 Category(ies) of Dementia - over 65 years of age (1), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (14) Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2005 Brief Description of the Service: Penmeneth is situated in Hayle, West Cornwall. The property provides care and support for up to 14 elderly service users. The home offers residential care for up to fourteen elderly people, one of whom could have dementia and one a mental disorder. Accommodation is provided on two floors, the first floor can be accessed by a stair lift. There are three smoke free lounges, and there is a small-seated area for service users who smoke. There is a small garden to the front of the home and a courtyard at the back with bench seating. There is limited roadside car parking. Wheelchair accessibility is very limited. The registered providers Mr and Mrs Richards- live nearby, and are in control of the day-to-day running of the home. A copy of the inspection report is available in the rear lounge, and it is suggested a copy is requested from management if required. The range of fees at the time of the inspection is £293-£340 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Inspection took place in twelve and a half hours over two days. All of the Key Standards were inspected. The methodology used for this inspection was: • To case track four service users. This included, where possible, meeting and discussing with the service users their experiences, and inspecting their records. • Discussing with four staff their experiences working in the home. • Discussion with other service users and their representatives. • Observing care practices. • Discussing care practices with management. • Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received from the home (e.g. regarding any incidents which occurred), was used to help form the judgements made in the report. What the service does well: What has improved since the last inspection? What they could do better: Although service users who are funded by Cornwall Adult Social Care (Social Services) receive a contract, a contract needs to be provided to privately funded service users. This will ensure they are aware of their rights and responsibilities. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 6 The medication system is generally well managed however the registered providers need to check staff are always signing administration records when medication is administered. There is a good bathing facility on the ground floor, however there must be a satisfactory bathing facility on the first floor of the home. Although staff turnover is very low, and staff appear competent, staff recruitment records need to be improved for new staff so it is evident appropriate recruitment checks are taking place. Although training is developing within the home quite well, there are still some gaps in training required by regulation; for example moving and handling training and first aid. The registered provider has said this issue will be addressed. 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. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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 Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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): 2,3 Quality in this area is generally good. The judgement has been made using available evidence including a visit to the service. Service users funded by Cornwall County Council receive a social service contract at the time of admission. This enables service users to be aware of their rights and responsibilities. However privately funded service users need to be issued with a contract between the registered provider and service user at the time of admission. The pre admission assessment procedure is good, and enables the registered persons to ascertain they can meet the needs of service users, before admission is arranged. EVIDENCE: Copies of social services contracts were available for inspection. However, if service users are privately funded, they need to be issued with a contract between the registered provider and service user. The format the home has developed for this purpose is satisfactory. The registered provider assesses service users before they are admitted. Mrs Richards said service users or their relatives could visit the home before formal admission was arranged. Otherwise Mrs Richards will visit the service user, and talk to other relevant parties before the service user is admitted. Some service Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 9 users said an assessment was completed before admission was arranged, although others could not remember this happening. Copies of assessments were available for inspection in service user files. It is suggested contemporaneous notes of pre admission assessments are retained for inspection. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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, 11 Quality in this area is generally good. The judgement has been made using available evidence including a visit to the service. All service users have a care plan and these are reviewed. This ensures staff have suitable information to provide care, and care plans are amended when changes in service users’ needs occur. Healthcare support seems appropriate so service users can be assured they will receive suitable support from medical practitioners. The operation of the medication system is generally satisfactory, although greater care must be taken regarding signing for medication. Staff work with service users in a manner, which respects their privacy and dignity. Caring of the dying seems to a very good standard so service users can be assured they will be cared for appropriately in their final days. Issues regarding the diverse backgrounds of service users appear suitably addressed. EVIDENCE: There is a copy of a care plan in each service user file. Staff said care plans were accessible to them. The care plan format is basic but satisfactory, and staff said they found the care plans useful. Service users and their relatives did not seem aware of care plans and did not seem to have any involvement in their development and review. Care plans are reviewed regularly when service users needs change, but not monthly as suggested in the National Minimum Standard. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 11 Service users said they were satisfied with the healthcare support they received. This includes visits from GP’s, district nurses, chiropodists, dentists and opticians. The registered providers have a satisfactory medication policy. Medication is administered via the monitored dosage system. The system was generally satisfactory; storage was generally fine and records appropriate. However there were some gaps where medication was not signed for, although it appeared to be administered. Service users said they felt staff worked with them in a manner, which respected their privacy and dignity. Service users were positive about their care. The inspector spoke to several service users’ friends and relatives who were all positive about staff, management, service user care and the home. Service users said personal care was provided to a good standard. The registered provider has a policy regarding death and dying which is acceptable. Care of the dying however appears very good. Staff sit with service users if requested. There are suitable links with health care professionals and other organisations e.g. Macmillan nurses, if these services are required. The registered provider has a satisfactory policy regarding anti discrimination. There are currently no service users from ethnic minorities, although the registered providers stated they would be more than happy to accommodate service users from other cultures. The local population is predominantly Cornish, and from ‘White-UK’ background. Issues regarding sexuality, gender and disability seem to be suitably addressed. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. Routines are satisfactory so service users can live a lifestyle that meets their needs. Visiting arrangements are flexible. Arrangements to assist service users with their finances are satisfactory so service users can maintain choice and control over their lives. Meals are provided to a good standard, so service users receive a wholesome and nutritious diet. EVIDENCE: Service users said they could get up and go to bed when they wished. Most of service users spend the majority of their time in one of the lounges. The registered provider said service users could spend time in their bedrooms if they wish. One person said one member of staff would assist service users to get to bed by 2200. The registered provider said they would look into this matter, as they are committed to ensuring service users have a choice when they get up and go to bed. There are some organised activities for example bingo and various board games. An organist also visits the home. Some activities are also organised outside the home; for example the registered providers said they regularly take service users out in the car, and some service users attend a day centre. Service users generally do not appear to be interested in attending religious services so none are organised in the home. However one service user has Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 13 regular visits from a representative of the church. Currently the library does not visit as none of the service users are interested in this service. Service users said they could receive visitors when they wished. The inspectors spoke to several service users friends and relatives who said they felt the home offered a good service. The registered provider assists with the management of money for some service users. Records kept are satisfactory. Service users said they either look after their own monies or these are managed by their relatives / legal representatives e.g. via power of attorney arrangements. Service users said they were able to bring small items of furniture and their belongings to the home. Service users said they enjoyed the food provided. A choice of a hot and cold evening evening tea is offered. Suitable records of menus are maintained. Special diets (e.g. pureed meals) are provided as required. Although a choice of main meal is not provided, service users said staff were aware of preferences, and an alternative is provided where necessary. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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, 18 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. The registered providers have suitable procedures regarding complaints and adult protection. Subsequently service users can be assured there are appropriate procedures to deal with any concerns or bad practice. EVIDENCE: The registered provider has satisfactory procedures regarding complaints and adult protection. Staff and service users showed some awareness of the procedures, and were able to say whom they would approach if they had a complaint or were concerned about abuse. Most staff have attended adult protection training, which staff said was useful. Staff and service users all said they had not witnessed any bad or abusive practices. All staff have Criminal Record Bureau check, and a Protection of Vulnerable Adults check (where applicable). Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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, 21, 26 Quality in this area is generally good. The judgement has been made using available evidence including a visit to the service. Penmeneth provides a pleasant, homely, clean and well-maintained environment for service users to live and feel at home in. However bathing facilities upstairs need to be improved. EVIDENCE: The building was inspected. The building appears to be well maintained, clean, pleasantly decorated and homely. There is a small but pleasant garden, which service users can use. All communal rooms are homely and comfortable. There are three lounges, and a ‘snug’ area where service users can smoke. Service users have their meals in the lounge / dining area at the rear of the home. Bedrooms are individualised and comfortable. A stair lift is provided to assist service users to go upstairs. All decorations are maintained to a very high standard. There is a ‘Parker’ bath facility on the ground floor, which offers a good facility particularly for those who are frail or have a mobility problem. However the Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 16 upstairs bathroom has been converted to a sleep in bedroom for staff. The registered provider said this was done as the bathing facility was not used. However this has resulted in there not being a bathroom on the first floor of the home. Staff and the registered providers do not feel this is a problem as service users tend to bathe in the evening before going to bed, rather than being put to the inconvenience of having to go downstairs first thing in the morning. However, there needs to be a facility on the first floor, for example if a service user is incontinent, the current facilities could result in inconvenience and difficulty. Service users also should be given a choice where to bathe. It is suggested it would be useful to at least have a shower room on the first floor. Suitable kitchen and laundry facilities are provided. Cleaning staff are employed, and the home was clean and hygienic at the time of inspection. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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 Quality in this area is adequate. The judgement has been made using available evidence including a visit to the service. Staffing levels appear satisfactory so service users can be assured they will get suitable levels of staff support. Recruitment records need improvement so service users can be assured there are suitable recruitment procedures and checks in place. Staff training provision needs improvement so staff receive appropriate training as required by regulation. This will assure service users that staff have suitable skills and knowledge to cater for their needs. Equal opportunities issues regarding recruitment and work practices seem satisfactory. EVIDENCE: Rotas show three members of staff are on duty from 0800 to 1200. (Two of which are on duty from 0800 to 1500). There are two staff on duty from 1500 to 2200. There is one waking night staff on duty from 2200 to 0800, and one member of staff sleeping in. Suitable numbers of staff were on duty on both days of the inspection. The registered providers also work in the home, and assist staff with providing care. The registered providers have a suitable approach to providing National Vocational Qualifications for care staff. Staff training required by regulation needs some improvement. This includes ensuring there is at least one member of staff with a first aid certificate (at appointed persons level) being on duty. Manual handling training needs to be updated as this was last completed in 2003. Most staff have infection control training, although some staff still need to receive this training. All staff that handle medication have received training. Some staff need to obtain food-handling training. Staff must receive fire Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 18 instruction e.g. when they commence employment, and at least annually (e.g. by a trained fire warden). Staff have received training regarding the needs of people with dementia, Parkinson’s Disease and abuse since the last inspection. Some staff have also completed a correspondence course regarding ‘Care Skills’. The registered provider said they have arranged further medication training. Fire training and first aid training will commence shortly. Recruitment records were inspected. Most staff have been employed for some time. Some records-required by regulation- were not available. For example all staff need to have a copy of an application form, and evidence confirming identity (e.g. birth certificate.) Records of two staff recently employed were very patchy- for example copies of references and staff induction were not available. Advice was given regarding what information needed to be covered and recorded on an induction checklist. All staff have a Criminal Records Bureau check (and Protection of Vulnerable Adults check-as applicable). The registered provider’s approach to equal opportunities and anti discrimination is satisfactory. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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 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, 33, 35, 38 Quality in this area is good. The judgement has been made using available evidence including a visit to the service. The registered providers appear to be suitably experienced and qualified to manage the home. There is a satisfactory quality assurance system in place. The registered providers approach to handling service users monies is satisfactory, so service users can be assured their financial interests are safeguarded, where the registered providers are involved in this area of their lives. The management of health and safety issues is good so service users can be assured they live in a safe environment. EVIDENCE: The registered providers appear caring, approachable and competent. The staff the inspector spoke to say the providers were good to work for, and provided sufficient guidance and support to help them to do their jobs. The providers work day to day in the home and have a good knowledge of service users. Discussion took place regarding the appointment of a registered manager, as although Mrs Richards is a qualified nurse, neither Mr nor Mrs Richards has an NVQ 4 in management. Service users and relatives of service users were Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 20 positive about the registered providers approach. The registered providers have a suitable approach to quality assurance. A survey has been completed of stakeholder views and these are positive. This needs to be completed at least annually and where necessary an ‘improvement plan’ developed. There are also a considerable number of letters thanking the staff and providers for their support with service users. The registered providers look after some service user monies, for which suitable records are maintained. The inspector also spoke to the representative for one service user who had power of attorney and paid fees for their relative. They said invoicing was clear and there was no issues regarding this. The registered provider acts as agent for one service user’s benefits for which suitable records are kept. The registered provider has a health and safety policy. Records kept of checks required by regulation are satisfactory. For example there are suitable records of the testing of fire equipment, gas and electrical appliances and the electrical hardwire circuit. Accident records are suitably maintained. Health and safety risk assessments are satisfactory. There is a suitable risk assessment regarding the prevention of Legionella, and appropriate control measures are in place. There are some gaps in health and safety training as highlighted in the ‘Staffing’ section of the report. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 Page 22 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 OP2 Regulation 5 Requirement Service users who are privately funded need to be issued with a contract by the registered provider for example using the format previously developed by the registered provider. The registered provider must ensure staff always sign medication sheets when medication is administered. The registered provider must provide a suitable bathing facility on the first floor The registered provider must complete appropriate recruitment checks. There must be suitable recruitment records maintained on personnel files for all new staff employed from the date of the report. The registered providers must provide staff with suitable training to do their jobs and meet regulatory requirements. Suitable evidence of training must be maintained. This must include: • Regular fire training • Accredited training in DS0000009128.V296278.R01.S.doc Timescale for action 01/10/06 2 OP9 13 01/08/06 3 4 OP21 OP29 16, 23 17, 19 Schedule 4.6 01/07/07 01/08/06 5 OP30 18 01/12/06 Penmeneth House Version 5.2 Page 23 • • • • food handling (if food is handled) Infection control First aid (i.e. there must always be a member of staff qualified to appointed person level on duty) Manual handling. A suitable induction when they commence employment. 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 Contemporaneous notes of pre admission assessments are retained for inspection. Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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 Penmeneth House DS0000009128.V296278.R01.S.doc Version 5.2 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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