Inspection on 12/06/07 for Portland Avenue 35-37

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Portland Avenue 35-37 10/02/06

Portland Avenue 35-37 18/11/05

Portland Avenue 35-37 21/10/04

Portland Avenue 35-37 29/06/04

Portland Avenue 35-37 09/12/03

Portland Avenue 35-37 20/08/03

Portland Avenue 35-37 06/11/02

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

CARE HOME ADULTS 18-65 Portland Avenue 35/37 35 Portland Avenue Seaham Durham SR7 8AL Lead Inspector Ms Kathy Bell Key Unannounced Inspection 12th June 2007 10:30 Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Portland Avenue 35/37 Address 35 Portland Avenue Seaham Durham SR7 8AL 0191 5810741 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) European Services for People with Autism Limited Mr Jason Carroll Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th February 2006 Brief Description of the Service: Portland Avenue provides care, but not nursing care, for four adults with autism. The amount of support given is dependant on need. Some people living there live almost independent lives whilst others have much greater support. The service is provided in two separate bungalows sharing the same garden. It is situated close to the centre of Seaham and gives easy access to public transport to the major northeast cities. The home is fully supported by an experienced staff team. The registered manager is working in another home at the moment, but an experienced manager from another ESPA home is acting as manager. The home has provided the information that the average fee is £66,000 a year. This information was provided in February 2007. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during one day in June 2007. It was the one inspection planned for this year. The home did not know when it was going to happen but the Inspector telephoned before she visited, to make sure that someone would be in the building. The inspector looked around the building, though not every bedroom, and at records kept in the home. One resident has communication problems and another did not want to talk to the inspector but all four residents had been helped to fill in survey forms before the inspection. Three relatives had also filled in survey forms and two of them were available to talk to the inspector during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The acting manager must check that people responsible for one residents health care are satisfied that he does not take emergency medication with him when he goes out alone. Staff must make sure that the list of all medication each resident takes is always kept up-to-date. The acting manager must check the risk assessments about the supervision each resident needs when they take baths etc and review staffing arrangements for the times when only one person is on duty. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 6 Everyone must take part in a fire drill every six months and staff must receive fire safety training every six months and every three months for everyone who does night duty. The home must produce a written fire risk assessment which will explain how they will control the risks of fire and look after the safety of staff and residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A very detailed assessment is made of each residents needs before they are admitted. This is so that the home can be sure it will be able to meet their needs and they will be compatible with other residents. EVIDENCE: Before admission, ESPA collects information from parents and obtains assessments from their own speech therapist, psychologist etc. This information is considered by their admissions panel before and admission is agreed. The last stage of the process is a visit to the home. A record was seen of an overnight stay by the newest resident. Staff had used this as part of the assessment process and looked at what help the person needed and how they got on with the other people. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan which explains the care and support staff need to give. This helps staff provide the care in a consistent way and in the way residents want. Residents make choices about their daily lives and can take risks as part of being independent. EVIDENCE: The care plans seen were very detailed and they cover all aspects of residents lives, from personal care to daily activities. They include individual goals and the daily recording focuses on how the resident is working towards these goals. The care plans show that staff support people to be as independent as possible. The care plans include specialist assessments from ESPAs own speech therapist and psychologist. Staff also have detailed guidelines to tell them how to respond if a resident is becoming upset about something. The inspector saw that they were following these when they needed to do so at one point during the inspection. The care plans showed how staff had updated them when things had changed . Formal reviews are held every six months. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 10 For most residents, staff were checking every month how well residents were working towards their goals and updating what they needed to do to support them. This is a good practice but they should make sure that these updates are always included in the main care plans. The care plans and daily activities planned show that residents are making individual choices. The care plans explain how staff can help people make choices, and sometimes record when someones ability to make choices is limited. Staff record when they have used particular techniques to help someone express their views and choices. One person, with communication difficulties, has cards to help him say what he wants. One resident described how he can choose how he spends his time and whether he wanted staff to spend time with him. He also said he had chosen where to go on holiday. In the surveys, residents said that they could make choices about their daily lives. However, relatives made the point that staff do have to set some boundaries, in the best interests of residents. The design of the home gives people opportunities for more independence but the home has recorded how it assesses whether it is safe to leave people unsupervised. One resident goes out independently but has a mobile phone to help him stay safe. The risks involved in people taking part in everyday activities, such as cooking, have been assessed, and staff put in safeguards to reduce the chances of accidents happening. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have an active lifestyle and take part in different activities according to their individual wishes. Staff support them keeping up contact with their families. The home respects residents rights and recognises their responsibilities. Staff try and promote a healthy diet for residents but this has been difficult for some residents. EVIDENCE: Residents take part in a range of different activities. One goes to a college run by ESPA, where various activities, including swimming, dance and drama, and education are available. Other residents go to ESPAs day service where they take part in trampolining, art, and dance and drama. One attends a vocational skills unit as well. People also use local community facilities, like pubs, shops and the cinema. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 12 Residents have been able to keep up contact with their families and are sometimes prompted to telephone home. Relatives said they could phone at any time. One said that staff , always make sure my son gets home to me when I ask. Residents have opportunities for social contact with residents from other ESPA homes at shared social events like barbecues. Records showed that staff consider residents rights. They record that people are able to have a front door key. One resident was interested in recent local elections and staff recorded how they had explained the right to vote to him. Residents are very involved in the daily life of running the home. Each week, time is set aside for deciding what food to buy and residents take part in shopping, cooking and help look after their rooms. Residents have a lot of choice in what they eat. They have individual meals and have a choice of take-away one evening in the week. Unfortunately some residents have quite fixed ideas about what they like to eat and this has meant their diet is often not very good. Staff are aware of this and have kept trying to encourage residents to eat healthily. The acting manager has been seeking advice from the dietician and is aiming to try harder to persuade people to try different foods. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents receive personal support which helps them be as independent as possible. The home makes sure that health needs are met. Arrangements for handling medication are generally satisfactory. EVIDENCE: Care plans provide very detailed guidance to staff on the help each person needs. The monthly reassessments show staff are looking carefully at whether someone is developing skills and whether staff are offering enough help. Records of healthcare show that the home follows up any medical problems. Staff can refer directly to a consultant psychiatrist who works closely with ESPA staff and clear records were kept of any changes in medication prescribed. There are records of regular checkups for eyes and teeth, and chiropody appointments are arranged. Relatives felt that health was looked after well. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 14 There is a generally sound procedure for handling medication. Staff have all received training in how to look after and give out medication safely. Staff were keeping a record to monitor how a resident was, after a change in medication, so they could give accurate information back to his consultant who had prescribed it. One resident is prescribed medication to be taken if needed for seizures, but does not take this with him when he goes out alone. There is a written plan for giving this medication, explaining when it should be given and who can give it. This has been agreed properly with healthcare professionals, but it does not cover situations when the resident goes out alone. Staff should check with people involved with his care to confirm this is alright and have his care plan amended. A sample of records showed that staff were generally following procedures but one error was found: staff had not updated the list of all the medication each resident takes, when a new drug for athletes foot had been prescribed. However the record of administration of medication showed that staff had been giving this to the resident, as they were meant to. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives can say what they think of the home and residents are protected from abuse as far as possible. EVIDENCE: ESPA has a satisfactory complaints procedure, which is available in a picture format for residents who would find this easier to understand. The home has recorded when they have tried to explain this to residents. In the surveys, residents said that they could complain if they wanted. Relatives confirmed that they were aware of the complaints procedure. In the survey they said that staff always or usually listened and acted on what they said. In the last year, the home responded to one complaint made about them and found that it was partly justified. The problem had been a lack of communication about possible future changes, at the right time, with relatives. Apart from this, the relatives felt that they could express their views on issues and received a satisfactory response. Staff have all received training in recognising abuse and understanding what they should do if they suspect it. ESPA has satisfactory procedures and has worked with care managers in following the procedures to protect vulnerable adults. Residents are protected because the home does not employ staff unless they have had satisfactory Criminal Records Bureau/POVA checks. Staff keep proper records of money looked after for residents and these are audited by ESPAs finance office, so there is someone outside the home who checks the money is correct. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, safe place to live in a domestic setting which meets residents needs. The home seemed clean on the day of inspection. EVIDENCE: The home consists of two semi-detached bungalows, each with two bedrooms and its own lounge/dining area and kitchen. Staff have an office and sleeping room in one bungalow and work between the two. They have assessed any risks to do with residents being in a bungalow when none of the staff are present and provide satisfactory levels of oversight. Although some refurbishment is the responsibility of the landlord, a housing association, a satisfactory standard of decoration and furnishing is maintained. The home seemed clean and staff have a schedule of cleaning and maintenance to be carried out on a regular basis. In the survey, residents said that the home was always or usually fresh and clean. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 & 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the right skills and personal qualities for their jobs and the home has achieved the target of 50 of the staff qualified to the level recommended in the National Minimum Standards or equivalent. There are enough staff on duty to help people lead safe and fulfilling lives, though the acting manager must check the arrangements when only one person is on duty. Staff receive suitable training and ESPA checks new staff to make sure they will be suitable to work with vulnerable adults. EVIDENCE: Three of the staff have already achieved the recommended minimum qualification for care workers, the National Vocational Qualification in care at level 2. Four other staff are working towards either level 2 or level 3. The deputy and the acting manager have completed a Certificate in Social Care. In the survey, relatives were asked if staff had the right skills and experience to look after people properly. One said usually and three said always. One relative described staff as, very caring. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 18 The rota showed that there are normally two or three staff on duty during the daytime, including the manager. One of the residents goes to college five days a week so staff only have to take him there and back. There are usually two staff on duty in the evening. Sometimes there has only been one member of staff on duty officially after 5 p.m. but staff said, when this has happened , that the manager or senior staff will work with them until after the busy evening meal time. The Inspector talked to staff about how they managed to particular times: when occasionally only one person was on duty in the evenings and in the mornings when only one person is on duty until 9 am. They all said that this was alright, because some people were quite independent and there was a set routine for giving people the help they needed in the mornings. One resident who commented on this said that staff do spend time with him if he wants them to. Staff had recorded how they had looked at what risks there were in people being unsupervised and felt it was safe. However one risk assessment suggested that someone needed more supervision than staff actually said he did. The acting manager must review these risk assessments and check again that current staffing arrangements are satisfactory. The records of the recruitment of staff who have joined the home since the last inspection were not easily available to look at. But ESPA has an established system for recruitment, which includes all required checks. Inspections of this home, and other ESPA homes in the area, have shown that the company always follows these procedures. There is a comprehensive training system for new staff and existing staff. This includes key areas such as food hygiene and also subjects specific to the type of home, such as restraint and autism. One of ESPAs staff has had training which means she is qualified to provide other staff with training on restraint to the standard expected by the British Institute for Learning Disabilities, which is recommended for care home staff. Most of the care staff, have had training in diversity.This aims to make sure that they understand the need to respect everyones different needs and choices. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being managed by an acting manager at the moment but seems to be running well. In most ways, the home is a safe place to live and work, but fire safety training must be improved. ESPA has good systems to make sure it checks that its homes are being managed properly and providing care in the way which residents want. EVIDENCE: The registered manager has been in post for several years and has the required skills and experience. He continues to undertake training arranged by ESPA. He is working towards NVQ 4 in management and care but described some difficulties in obtaining the necessary support to do this. An acting manager is running the home at the moment. He has many years experience in managing care homes for people with autism and has achieved part of the recommended qualifications for managers. Staff felt that the home was running well and the change of manager had not been a problem. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 20 Attention is paid to making sure that the health and safety of residents and staff are protected. Regular safety checks and maintenance are carried out. But a fire risk assessment, which is required by law, was not available in the home. Fire drills had taken place but the records did not say who took part. All the residents and all the staff must take part in fire drills so they are familiar with what to do if an actual fire starts. There was not a record available of fire safety training either. ESPA has a number of systems to make sure that the home provides a good service. There is an annual development plan which is linked to individual goals for each resident. Each year residents and their relatives complete a survey so that ESPA knows what they think of the service. A senior member of the staff of ESPA visits the home once a month to check how it is running. The company has continued to develop its services and improve how it provides care. Portland Avenue 35/37 DS0000007564.V332414.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 2 X 4 X X 2 X Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 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 Standard YA20 Regulation 13 Requirement The acting manager must check that people responsible for one residents healthcare are satisfied that he does not take emergency medication with him when he goes out alone. Staff must make sure that the list of all medication each resident takes is always kept up-to-date. The acting manager must check the risk assessments about the supervision each resident needs when they take baths etc and review staffing arrangements for the times when only one person is on duty. Timescale for action 01/08/07 2 YA33 18 01/08/07 3 YA42 13 Everyone must take part in a fire 01/08/07 drill every six months and staff must receive fire safety training every six months and every three months for everyone who does night duty. The home must produce a written fire risk assessment which will explain how they will control the risks of fire and look after the safety of staff and residents. Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 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. Refer to Standard Good Practice Recommendations Portland Avenue 35/37 DS0000007564.V332414.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Portland Avenue 35/37 DS0000007564.V332414.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. 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