Inspection on 15/01/07 for Queens Care Centre

This inspection was carried out on 15th January 2007.

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

Queens Care Centre 06/01/09

Queens Care Centre 20/10/05

Queens Care Centre 13/05/05

Queens Care Centre 14/12/04

Queens Care Centre 14/07/04

Queens Care Centre 24/03/04

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Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Queens Care Centre Millard Lane Maltby Rotherham South Yorkshire S66 7NA Lead Inspector Bob Burkinshaw Key Unannounced Inspection 10:00 15th January 2007 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 Queens Care Centre DS0000003086.V306808.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. Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queens Care Centre Address Millard Lane Maltby Rotherham South Yorkshire S66 7NA 01709 818181 01709 769756 NONE www.queenscarecentre.co.uk Z.A.K. HealthCare Limited 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) Christopher Stephen Nicholson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service may admit up to 4 persons between the age of 55 to 65 years. 3rd March 2003 Date of last inspection Brief Description of the Service: Queens Care Centre is situated in Maltby within a short walking distance of all local amenities. The home is attached to a Health Centre from which the Registered Person operates his GP practice. The home accommodates older people that require 24-hour personal care. It is a purpose built home with accommodation situated on two floors; the first floor is accessible by a lift and staircases. All bedrooms are single occupancy with the exception of four double rooms, which at present have single occupancy and will remain so whilst occupied by the existing service users. There is an intention that in the future these rooms may be used for wheelchair users that need additional space (as opposed to double occupancy). There are two lounge areas, both of which accommodate dining areas and a kitchenette. The home has a non-smoking policy for both staff and residents. There is a pleasant, sheltered garden/patio area in front of the building. The home is owned and operated by Z.A.K. Healthcare. The current fees is £329 per week full cost; £47 per day. Further information is available in the home’s service user guide that is available both in written and CD-rom formats; these can be obtained from the Queens Care Centre. Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the Queens Care Centre on the 15th January 2007; it started at 10:00 and lasted for 4.0 hours. The inspector spent time with the registered manager, staff, residents and visitors. The inspection included a tour of the premises, reading documents, and examining the medication storage facilities. What the service does well: What has improved since the last inspection? What they could do better: Includes a current photograph of each resident on his or her personal records. Follow the Queens Care Centre policy for handling residents’ money. Support care staff by providing supervision at least 6 times a year. Make sure that the staff training programme for 2007 can commence. Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 6 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. Queens Care Centre DS0000003086.V306808.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 Queens Care Centre DS0000003086.V306808.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): 1,3,4,5. National Minimum Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Queens Care Centre management provide a wide range of information for prospective residents and their representatives. Assessments and opportunities to visit take place before admission. Care records are used to monitor that the Queens Care Centre is the appropriate placement for a resident. EVIDENCE: The records of the four most recent admissions to the Queens Care Centre were made available to the inspector. All four included contracts, full assessments of need, care plans reflected the assessment of need and daily records illustrated that staff were following the care plan. Care plans were reviewed on a monthly basis. The inspector tracked two of these residents by interviewing them regarding their opinion of the care provided at the Queens Care Centre, they confirmed that Queens Care Centre met their needs satisfactorily at this point in time. Respite care continues to be provided by the home. Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 9 This inspection visit coincided with the admission of a new resident and the inspector spoke with a relative who was present at the time of admission. They confirmed that visits to the home had been made prior to admission and the home’s management had provided information about the home’s services. The visitor added that another relative had been a resident previously at Queens Care Centre and their experience of the care offered during that time was positive. That experience had helped them in making the decision to choose the Queens Care Centre once again. The entrance hall to the home was full of information about the home and the choices and rights of care users. The Queens Care Centre has put the service user guide and statement of purpose on a CD-rom for prospective service users and their representatives as an alternative to printed information. Management and staff were readily available to talk to service users or their representatives about the Queens Care Centre services and elderly care in general. A discussion with a visiting District Nurse and the registered manager confirmed that there are no service users inappropriately placed at the Queens Care Centre. Queens Care Centre DS0000003086.V306808.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents receive a full range of local healthcare services as the need arises. Staff at the Queens Care Centre are trained to administer medication and follow the correct procedure in storing and distributing medicines; some residents medication files require a photograph of that resident. Service users and their visitors are treated with respect by staff at the home. EVIDENCE: The inspector looked at the care records of four residents; they contained individual needs assessments with plans of care for staff to follow. These records were correctly maintained but the inspector did find that staff were omitting to record on the daily sheets when baths had been given or declined, instead the phrase ‘all personal hygiene needs met’ was written down. This was discussed with the registered manager at the time of the inspection and he felt that staff were failing to give themselves credit for when they bathed a service user. The continuity sheets recorded how each resident responded to their care package and any necessary changes that were made. Care plans were reviewed at regular intervals; some plans had been amended within the timescale in response to the changing needs of residents. Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 11 Residents were registered with one of the four different health centres around the town of Maltby and a visiting District Nurse who served all of the local health centres confirmed that the Queens Care Centre staff work in a cooperative manner with health professionals in meeting the healthcare needs of service users. Dental and chiropody services were available via referral through the service user’s G.P. Healthcall provided a visiting optician service. None of the residents was responsible for their own medication although this facility was available. Staff were observed administering medications and providing appropriate support to residents. Service users and visitors stressed that staff were always keen and willing to help them. The rapport between staff, service users and visitors was good. Visitors spoke positively of the benefits and changes that had taken place with their relatives following admission to the Queens Care Centre and confirmed that care standards were good. The inspector looked at the storage, administration and disposal systems for the management of medication at the Queens Care Centre. All staff that administer medication have received training for the task. Medication administration records were correct and up to date. The home provided secure controlled drugs storage facility separate to the trolley storage; no controlled drugs were currently stored at the Queens Care Centre. Surplus drugs were returned to the supplier, Weldrick’s and the record showed that a signature from the pharmacist’s representative was obtained at the time of return. It is the home’s policy that a photograph of each service user is attached to the front of their medication file to ensure that the correct medication is given to the correct person; some medication files were missing a photograph. This omission was brought to the attention of the registered manager at the time of this inspection visit. Queens Care Centre DS0000003086.V306808.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager and his team have worked hard to build links with the local community. An activities organiser provides a programme of activities to meet service users needs. Visitors are welcome to visit at any reasonable time. Service users are offered a choice of meals each day, and the menus are well balanced to meet service users nutritional needs. Service users are encouraged to retain their independence. EVIDENCE: There were numerous visitors to the home throughout the day. They confirmed that they were able to visit at any reasonable time, with shift workers visiting at any other time by appointment. The home employs an activities coordinator who was on leave at the time of this inspection visit. Activities were organised on either a one to one or small group basis. Residents were observed to be reading, listening to music and watching television. The home contained numerous photographs that recorded the activities and events that take place at the home. None of the residents left the home unless accompanied by members of their family or staff and the inspector saw one service user go out to the local town Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 13 centre nearby accompanied by a visiting relative. Access to the nearby shops and central location help service users to retain their local roots and contacts. Nourishing fluids were readily available throughout the day. There was a choice of midday meal, staff were observed to encourage and assist with meals as needed. The inspector tracked one service user whose assessment included the need for assistance and a plate guard due to poor eyesight; he found that the plan was being followed. Mealtimes were unhurried with extra portions available as required. Relatives were pleased to be to assist their loved ones with meals. Specialist diets were available for those requiring this service. The NHS dietician had assisted with compiling the menu. Service users were at liberty to take their meals in their own rooms and staff were observed taking trays of lunchtime meals to those residents who requested this. Queens Care Centre DS0000003086.V306808.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff training in how to promote the home’s complaints and adult protection policies safeguards the welfare of service users. Service users feels safe and confident that any complaints will be taken seriously and dealt with quickly. EVIDENCE: Residents and visitors stated that they had no concerns or complaints about care or services provided. They confirmed that they had regular and easy access to the homes owners and manager and that any small points raised were dealt with promptly. Visitors confirmed this, they also confirmed that their particular relative would not hesitate to tell them or the staff of any concerns that they had. The home maintains a Complaints Book in which it records all formal complaints and the action taken in response; one negative comment had been entered since the last inspection and although the complainant did not follow through by making a complaint the matter had been taken up by the registered manager and shared with staff including clear instructions on how to prevent a reoccurrence. There have been no complaints made to the local Commission for Social Care Inspection office. There has been no cause to make an adult protection referral through the local Protection of Vulnerable Adults policy. The Queens Care Centre also has a whistle-blowing policy and records showed that staff training in abuse prevention took place last year. Queens Care Centre DS0000003086.V306808.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, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Queens Care Centre looked well maintained and had a clean and pleasant atmosphere. It is properly equipped for the care of elderly people and is safely maintained. EVIDENCE: The inspector was shown around the home by the registered manager. The homeowners have continued to redecorate and refurbish the home in line with their business plan. Individual bedrooms have been redecorated, re-carpeted and refurbished since the last inspection. This work is ongoing. Several bedrooms were visited; all appeared comfortably furnished and decorated. A number of residents and their families had taken the opportunity to personalise their space with personal effects and memorabilia. Toilets and bathrooms were readily accessible and equipped with aids and adaptations as required. Service users and family members spoken with were very satisfied with the building and its cleanliness. The corridors are wide and are fitted with handrails. Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 16 The home has pest control and disposal of clinical waste systems that were functioning effectively. The home had records of training provided for staff training in health and safety issues. Repairs and improvements in response to the requirements made following the last inspection had been met; this included the replacement of fluorescent light fittings with domestic type fittings. Externally the home was found to be in good repair; the gardens provide a pleasant outdoor sitting area that is used by residents in the warmer months. Fire safety records including fire safety inspections and risk assessments were up to date, they included evidence of fire training for staff and practices and building risk assessments. Maintenance records for hoists, and other moving and handling equipment were up to date. Queens Care Centre DS0000003086.V306808.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Queens Care Centre staff are trained and competent to do their jobs; they are on duty in sufficient numbers and are familiar with the residents that they care for. Further training is planned for the staff group in the year ahead. EVIDENCE: The staff on duty were working well together and competent in their approach to their work, they knew the service users in their care and approached them in a friendly and respectful manner. The staff group overall are a stable team and there has been very little turnover at the Queens Care Centre, this has benefited residents as staff get to know them well. Staff spoken to confirmed that not only were they well supported in their work but actively encouraged and supported to develop personally. Personnel files contained all the required documents including a record of formal interviews, references, CRB checks, equal opportunities forms and contracts of employment. There have been no new starters since the last inspection but one person was in the process of being recruited for bank (relief) work. The inspector saw that their references had been sent for; if these proved satisfactory then they will go through a Criminal Records Bureau check before being employed. At the time of this inspection visit there was one senior carer on duty plus 3 carers working a long day and 1 carer working a half-day. The registered Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 18 manager was also on site but his hours are not included on the care rota. The care team was supported by catering and domestic staff. One senior care and 3 carers provided waking night cover. These rota arrangements provided staff in sufficient numbers to care for the residents at the Queens Care Centre. Staff had undertaken statutory training and updates i.e. moving and handling, fire prevention etc, and were involved in National Vocational Qualification training and medication administration training. The Queens Care Centre care staff team has achieved the target of more than 50 of care staff trained to the National Vocational Qualification care level 2. The training plan for 2007 was made available for inspection and included mandatory refresher training in fire safety; moving and handling; medication administration; first aid; food hygiene; adult protection; COSSHH/ and dementia awareness; the registered manager reported that he was in the process of identifying funding to allow the programme to begin. Queens Care Centre DS0000003086.V306808.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, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and managed with all statutory servicing and checks complete. A detailed risk assessment and health & safety policy/procedure protects service users and staff. Quality assurance is employed at the home. The resident’s monies policy needs reviewing; the frequency of supervision is insufficient. EVIDENCE: The inspector saw that visitors to the home had ready and easy access to the homes owners and management. Mr Nicholson the registered manager is a qualified nurse with a wide range of skills and experience in elderly care. Staff expressed confidence in his management ability. He is ably supported by his deputy manager Ms N Starrs who is currently studying for her manager’s award. The inspector saw that there was always a senior member of staff on duty at the home with advice and support readily available. Dr Khan Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 20 (homeowner) visits the home daily and was observed conversing with residents and visitors as well as the staff and the registered manager. Risk assessments had been completed and were reviewed regularly. The manager met every week with the Director to discuss the operation of Queens Care Centre; these discussions included any quality issues. Dr Khan visits the home on a daily basis. Staff meetings were held every two months and a record was kept. Service user meetings were held every six months and an annual survey of relatives was carried out with the aim of encouraging feedback and observations about the quality of care at the home. The financial systems and overall budget management for the home is Dr Khan’s responsibility. Records showed that residents get their personal allowances from their families. The inspector found the money locked in a cashbox in a lockable room with records that showed income/outgoings and balances. Whenever money was passed to a resident or their representative a signature was obtained. A random sample of two residents’ monies was made; both were correct and receipts were present for any outgoings. The home’s residents’ monies policy requires two signatures when money is being disbursed and this was not being followed; the policy also required the manager or his deputy to audit the monies on a monthly basis and sign that they had done so; this was not being followed. The registered manager explained that his deputy manager now takes responsibility for the administration of residents’ monies and agreed that the policy needs reviewing. The records of annual staff appraisals and staff supervision were seen. The supervision records showed that the target of supervision 6 times a year was not being met although regular supervision was taking place. Fire safety records showed that an inspection by the South Yorkshire Fire & Rescue Service was satisfactory and that the fire-fighting equipment and alarm system were tested at the required intervals. Building maintenance checks were up to date. Queens Care Centre DS0000003086.V306808.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 3 X 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 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 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 X 3 Queens Care Centre DS0000003086.V306808.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 OP9 Regulation 13 (2) Requirement A current photo of each resident must be present on their personal medication record and/or personal file The Queens Care Centre policy on resident’s monies must be followed or reviewed to ensure that all safeguards are followed. The registered manager must ensure that care staff receive formal supervision at least 6 times a year. Timescale for action 31/03/07 2. OP35 Schedule 4 18 (2) 31/03/07 3. OP36 31/03/07 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 OP30 Good Practice Recommendations The registered manager should ensure that funds are quickly located to allow the 2007 training programme that is planned for staff to commence. Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Queens Care Centre DS0000003086.V306808.R01.S.doc Version 5.2 Page 24 - 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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