Inspection on 27/04/05 for Powys House

This inspection was carried out on 27th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Powys House 11/09/06

Powys House 12/10/05

Powys House 05/11/04

Powys House 11/05/04

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

CARE HOME ADULTS 18-65 Powys House 121 York Avenue East Cowes Isle of Wight PO32 6BB Lead Inspector Mark Sims Unannounced 27th April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Powys House Version 1.10 Page 3 SERVICE INFORMATION Name of service Powys House Address 121 York Avenue, East Cowes, Isle of Wight, PO32 6BB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01983 291983 Harrison Care Enterprises Ltd Mr Richard David Harrison Care Home 18 Category(ies) of Learning disability (9), Learning disability, over registration, with number 65 years of age (3), Mental disorder, excluding of places learning disability or dementia (2), Old age, not falling within any other category (3), Physical disability over 65 years of age (1) Powys House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 05/11/2004 Brief Description of the Service: Powys House is a large period building, which has been converted to provide residential care to a mixed client group, offering services to younger and older adults with learning disabilities, older persons, 2 places under the category of mental disorder and 1 category for someone with a physical disability. The premises is situated about midway along York Avenue, East Cowes, which is the main thoroughfare into the town and provides service users with easy access to the facilities and amenities of the East Cowes, including sources of transport. The building, as highlighted, is a period town house, which has been extended and adapted to provided residential accommodation, including a passanger lift servicing all floors, portable ramped access to the home, assisted bathrooms, etc. Powys House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and formed the first inspection of the 2005/2006 inspection programme. As the service predominantly caters for younger adults with Learning Disabilities the inspection took place in the late afternoon, ensuring that the inspector was available to meet with residents as they returned from a variety of day centres. The inspection lasted approximately 4 hours and considered issues identified during the previous inspection cycle, as well as focusing on issues directly affecting the service users, the latter gauged by spending time with the service users and staff within communal settings. What the service does well: What has improved since the last inspection? The newly appointed deputy manager has greatly influenced the staff’s opinions or acceptance of training programmes, especially National Vocational Qualifications and Learning Disabilities Award Framework (LDAF), staff Powys House Version 1.10 Page 6 discussing their training opportunities openly and the reservations they held prior to the new deputy commencing her employment. Several of the requirements and recommendations raised against the home at last year’s announced inspection have been addressed: amended service users’ guide and statement of purpose, amended policies and procedures for staff, access to LDAF training for staff. However, one or two areas still remain outstanding: reviewed contracts for service users, amended induction and foundation programmes for staff, etc. and these should still be actioned. The stairs leading to the lower ground floor have been widened in an attempt to create a safer route for accessing the kitchen, laundry and administrative office. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Powys House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Powys House Version 1.10 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 standard(s) ST 5. The proprietary company has not yet updated the terms, conditions or contracts of service users, as recommended at the last inspection visit. EVIDENCE: In discussion with the manager, who is also a director for the proprietary company, it was established that the process of updating the contracts/terms and conditions for service users had not yet commenced, a statement confirmed on inspection of the service user files. Whilst this appears to have no direct impact on the service delivered to the residents it is important to remember that management of a home is expected to be accountable for delivery of promised services under a written contract between the home and the resident. For a number of service users, residing at Powys House it will be necessary to produce the contract, terms and conditions in a format that is understandable, as for some the written word may not be their first choice of language. Powys House Version 1.10 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 standard(s) St 6, St 7, St 9. Each service user has an individually written and prepared care plan, which stems from an initial assessment of need and information provided by professional agencies involved with the resident. These plans, whilst new to the service are currently not being maintained adequately, with information being recorded within the wrong sections of the plans and/or information, which should spur staff onto the creation of specific care plans documented but not progressed accordingly. Observations and interactions with service users evidenced that people are both encouraged and supported in making decisions about their own lives and activities. Any elements of risk taking, with people’s lives should be appropriately assessed and plans produced to reduce any likelihood of harm being caused. EVIDENCE: A review of three service users’ plans took place at this inspection, revealing a mixed approach to the maintenance of service users’ plans. Each service user is allocated a key worker, who is responsible for supporting the resident and for maintaining and updating their care planning files. Powys House Version 1.10 Page 10 The care planning system used in the home is relatively new to the staff and was only introduced last year, following the takeover of the business. The care planning system is a structured tool, which if used appropriately should ensure that service users are provided with a suitable care-planning package. However, staff are presently not using the service user plans correctly with information not recorded within the sections provided, documented information focusing on the tasks performed with service users and not evidencing the positive work carried out in supporting service users and care plans not being generated in response to changes in the service users’ immediate needs. Evidence of such incidents were noted on all three plans but was typified by incidents such as staff not recording the involvement of a General Practitioner in prescribing a topical application for the treatment of a fungal infection and no temporary care plan being created with regards to the treatment and monitoring of the condition. The care plan of a service user who had experienced a recent bereavement was found to contain evidence that staff understood and appreciated the sense of loss and emotional turmoil the person might experience and that they were supporting the person in selecting flowers and attending the funeral, etc. However, they had failed to record that they had also arranged for counselling should it be required or again created a short-term/temporary care plan to guide all staff during the period immediately following the person’s loss. Through discussions with the management, staff and residents it was obvious that people are involved in the care planning and review process for their care, although the level of people’s appreciation of what these processes mean is linked directly to their levels of comprehension, the notion of planning the delivery of your care being alien to most people. Where the service predominantly specialises in the delivery of care and support to people with learning disabilities the home’s current care planning programme will undoubtedly need to change with the introduction of Person Centred Planning, a concept which might ensure far greater understanding for people of what a plan of care, etc. is intended to achieve. Time was spent socialising with service users during the inspection, which proved a useful tool in the gauging of people’s rights to self-determination and independence. People spoke freely about the day services they visit, friendships within the home, staff and key workers, trips out with the manager, which appear exceptionally popular events and general experiences of living within the home. People also exercised their right to self-determination whilst socialising with the inspector, some people opting not to attend an evening club in preference for staying at home, some people deciding to take specific items with them to the centre i.e. guitars, so they could participate in musical sessions. Powys House Version 1.10 Page 11 Powys House Version 1.10 Page 12 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 standard(s) St 12, St 13, St 14, St 17. Many of the service users are involved with day centres and work opportunities designed specifically to meet the needs of younger people. The management, staff and residents use many of the local facilities of the town, including pubs, clubs and shops. The service users discussed openly the social and leisure activities they pursue and seem happy and content with the range of entertainments available both internally and externally of the home. The meals served appeared both appetising and varied and met with the needs of the service users, as evidenced by their enjoyment of food and comments. EVIDENCE: Time was spent socialising with the service users both during tea and later, as they relaxed before attending a local social club, which from observations is not a set or established routine for people, as they obviously choose whether or not to attend on the night, some people opting to go and some unsure following busy days at various day services. Powys House Version 1.10 Page 13 People were generally very chatty throughout my time with them and discussed a wide variety of topics, including day services, relationships (both within the home and externally), staffing and social outings (especially those undertaken by the managing proprietor), service users recounting their last outing, a visit to a public house in Arreton called the White Lion, which was obviously a successful and enjoyable trip. In addition to those visits or outings with the manager are supported outings undertaken by staff, both socially and on a more formal basis, as observed during the visit when a resident was escorted to the hairdressers by her key worker. The home’s mealtimes were arguably amongst the most social and relaxed the inspector has witnessed with staff and service users interacting with each other, joking about menu options, talking about events of the day, etc. The food served was generally of good quality and all meals were individually portioned and intended to reflect the likes, dislikes and choices of the residents. In conversation with staff shortly before the teatime meals were served, it was established that since the new proprietary company has taken over spending on food products has increased, leading to better quality food produce being available in far greater quantities and varieties. Staff evidenced their views via both the stores within the kitchen and drawing the attention of the inspector to the fruit bowl, which is constantly full and accessible to people within the lounge. Comments were not made by the service users, regarding improvements within the meals served, although generally they seemed to enjoy the food provided and the choices available, both of main meals and snacks. Powys House Version 1.10 Page 14 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 standard(s) St 19, St 21. The staff were able to demonstrate a clear understanding of the emotional and physical health needs of service users, although improvements to recording practices are required to ensure these are appropriately documented. Whilst the specifics of the aging process or the death of a service user did not arise during the visit the supportive nature of the staff towards service users experiencing loss demonstrated sufficiently their ability to respond to and support individuals appropriately. EVIDENCE: As previously indicated within the body of this report the staff of the home had demonstrated a keen understanding of the needs of the service users, when challenged emotionally, as typified by the arranging for additional counselling visits for a service user, if required, following a recent bereavement. Staff were also observed supporting people on their return from day services, where some people’s experiences had left them emotionally charged and stimulated. Staff were noted to be very calming and willing to listen and advice (appropriately) during these early interactions and appeared to use a multitude of skills to defuse or placate the situations, giving the service users time to relax and compose themselves. Powys House Version 1.10 Page 15 Specific issues relating to aging and death, with regards to the service users were topics that never arose for discussion or exploration. However, as already mentioned the recent bereavement or loss experienced by a member of the service user group provided the inspector with an insight into how staff might address such a difficult and challenging subject with residents, the indication being that they would respond appropriately from both a personal and professional perspective, supporting the service users and seeking suitable professional advice. Illness, the third concept identified under Standard 21 for consideration whilst undertaking the inspection, again provided evidence of some common themes with the practice of the staff. Firstly that staff provide a good and responsive service to the residents when medical or health care is required, as evidenced through records where visits from and to General Practitioners (GPs), etc. are documented. Secondly that the staff have an understanding of the ailments suffered by particular residents and how these affect that person individually, as evidenced through observations of staff when considering the evening meal, etc. and possible effects on diabetes. However, as previously highlighted the staff do let themselves down by not documenting correctly their interactions with GPs or the treatment plans prescribed, etc. following consultations. Powys House Version 1.10 Page 16 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 standard(s) St 22. The service users were confident that their views and opinions would be listened to and acknowledged during interactions with staff. EVIDENCE: Throughout the time spent with the service users it was clear that they have good relationships with the staff and that they are happy to discuss issues of concern or day-to-day life without fear of being ignored or rebuffed. Examples of this coming mainly in the build up to the service users leaving for the evening social club, where one resident was taking their guitar along for a tutorial, which prompted another resident to ask if it would be okay to take their guitar, which turned out to be a replica instrument but to which staff responded positively and with encouragement. Another example of the confidence service users have in the responsiveness of staff, to questions or discussions affecting their emotional lives, came whilst a service user was expressing their fondness for a worker at the social club. This relationship obviously meant a lot to the resident who had spent time preparing to visit the club, but who through interactions with the staff understood the limitations of the relationship. The kind of work undertaken by staff, especially when supporting a resident through the turmoil of human emotion should be documented, yet again the staff demonstrated that this part of the caring process is beyond them at this time, as nothing within the service user’s plan related to this relationship or how the resident should be guided in embracing their feelings. Powys House Version 1.10 Page 17 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 standard(s) St 24, St 30. The environment has a lively, enthusiastic sense about it, which is reflective of the service users and how they seem to like to live their lives. This vivacious atmosphere also has a feel of community and togetherness and helps create a truly homely essence. The premises was well maintained, clean and tidy both internally and externally. EVIDENCE: On arriving for the inspection I was greeted by two of the service users, who were sat outside enjoying the warmth of the early spring sunshine and who automatically came across to speak to me as I made my way to the house. The two individuals keen to know who I was and why I was there, before choosing to tell me about themselves and express their contentment with live at Powys House. The welcome provided by these residents continued within the home, where the staff were also very friendly and hospitable and the manager open, courteous and co-operative. Powys House Version 1.10 Page 18 As people start to arrive back from day services the atmosphere within the home starts to evolve and take shape, with a lot of laughter and noise audible around the home. Observations of mealtimes and social occasions (post the evening meal) reinforced that the service users as a group get on well together and that generally they have formed good relationships. People joking, organising each other, able to discuss in detail aspects of each other’s lives, etc. which would not occur if people did not take interest in each other. In addition to the atmosphere created by the resident group and staff, is the environment, which is open, spacious and comfortable, much of the inspector’s time spent with the service users was spent in and around the lounge and dining room, the focal points of the home for the residents. The environment within both the lounge and dining room are comfortable and well decorated. Sufficient seating space is provided, although the resident group is quite transient and come and go during the day/evenings as they please. The lounge, as perhaps with any lounge is equipped with a wide screen television, video and stereo system. Throughout the inspector’s time in the home, no area of the premises visited was noted to be unclean, unhygienic or malodorous. Powys House Version 1.10 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 32, St 33. The management has been able to establish a settled and stable staff team, blending maturity and experience with youth and enthusiasm, the introduction of the new deputy manager’s position has gone a long way towards supporting this process and helping staff appreciate their capabilities, educationally and so embracing National Vocational Qualifications (NVQ) and Learning Disabilities Award Framework (LDAF) training. EVIDENCE: Several staff, including the deputy manager were spoken to during the visit, with training and education being one of the topics discussed during the meeting. It was evident at previous inspections that staff were a little reluctant to enter into training, which they felt was too academic and therefore of no direct correlation to the roles they perform. At this visit it was clear that this impression or belief had been stripped away and that staff, through a process of encouragement and support, were being introduced to the benefits of National Vocational training opportunities and specialist training programmes like the Learning Disabilities Award Framework, designed as an introduction to the field of learning disabilities care and support. This was not to say that all staff appreciated the often complex way that NVQ questions or units were phrased, as from comments received they were not. Powys House Version 1.10 Page 20 However, thanks to the commitment of the proprietary company and the backing of the manager and deputy manager, staff had embarked on NVQs from level 1 to 4 and were awaiting the commencement of the LDAF training programme, the deputy manager sourcing a mainland provider willing to train the staff team. It was also evident given that the deputy manager and one of the care staff returned to the home at the end of a day’s training at the college, that additional educational programmes are being made available to staff, courses such as first aid, etc. Powys House Version 1.10 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 37, St 40, St 41. The recruitment of a new deputy manager has provided stability and support to the manager, staff and service users. A review of the home’s procedure for the management of service users’ finances evidences that people’s best interests are safeguarded by the home. The proprietary company/manager has introduced new care planning documentation, which still is not being used appropriately or accurately by staff. EVIDENCE: In discussions with the manager and staff it was clear that the newly appointed deputy manager has settled into the role well and has begun the process of reviewing the home’s policies, procedures and administrative systems. The manager and his deputy appear to have established a good working relationship, the manager pleased with the deputy’s drive and determination Powys House Version 1.10 Page 22 and the deputy manager seems satisfied with her position and the opportunities this has opened up with regards to the future day-to-day management of the home. During observations, and later when asked, the service users see the deputy manager as approachable and nice and were quite willing to acknowledge/greet her as soon as they were aware she was available within the building. The manager was praised by the staff for his approach to the service users, which was described as excellent, as he puts the residents first before anything else, his expenditure on food used to evidence this, given the staff opinion that the previous proprietor(s) ‘spent little on quality food products, his willingness to spend time sitting talking and eating with the service users and the time he spends taking people out socially, which people really seemed to enjoy’. The influence of the new management structure/team could also be seen through procedures such as the financial management of service users’ monies, with three accounts audited during the visit, each containing accurate balances, each stored individually and appropriately secured, all three containing double signature and receipts for purchases available. As highlighted repeatedly throughout this report the one area of the home’s practice which continually lets it down is the staff’s approach to record keeping. It is acknowledged that under the previous proprietor(s) records were poorly produced and maintained, with no structure or training available for staff to help equip them with the demands of documented evidence. However, the new company introduced a new structured care planning system shortly before the November 2004 inspection, which should by now be familiar to staff and which should be being completed appropriately. However, as indicated within this report fundamental mistakes are being made, with notes recorded within the wrong sections, important care planning information not documented and information that is documented not used in the creation and development of care plans. Powys House Version 1.10 Page 23 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 2 Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 x 2 Standard No 37 38 39 40 41 42 43 Score 3 x x 3 2 x x Powys House Version 1.10 Page 24 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 St. 6, St 19, St 21, St 41 Regulation Requirement Timescale for action 23.06.05 Regulation The management must address 15 the shortfallings of the staff, who fail to document care needs and treatments plans appropriately or record much of the good work being undertaken in the support of service users. 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 St. 5 Good Practice Recommendations The contract, terms and conditions documents should be reviewed and made available in an appropriate format for the service user. Powys House Version 1.10 Page 25 Commission for Social Care Inspection Mill Court Furrlongs Newport PO30 2AA 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 Powys House Version 1.10 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!