CARE HOMES FOR OLDER PEOPLE
Queensmead 1 Bronte Avenue Christchurch Dorset BH23 2LX Lead Inspector
Trevor Julian Unannounced Inspection 8th December 2006 09:30 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 Queensmead DS0000026862.V323327.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. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Queensmead Address 1 Bronte Avenue Christchurch Dorset BH23 2LX 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) 01202 485176 01202 487805 queensmead@dorsettrust.co.uk www.care-south.co.uk Care South Mrs L Thornhill Care Home 40 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (36) Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 36 in the category OP (Old Age) and 4 in the categories DE(E) and/or MD(E). 23rd January 2006 Date of last inspection Brief Description of the Service: Queensmead is registered with the Commission for Social Care Inspection to accommodate 40 older people; this includes 4 places for people with a diagnosis of dementia or mental illness. Queensmead is operated by Care South, a non-profit making organisation with several residential homes and community services across the South West. Mrs L Thornhill is the registered manager. The home is situated in a residential estate close to Christchurch Hospital and one mile from the town centre. Queensmead is a purpose built home set in large, well-maintained grounds. Local shops and amenities are available within a short distance. The premises extend over 3 floors with service users accommodated on every floor. The ground floor comprises of 11 bedrooms, an assisted bathroom, 8 separate toilets, a dining room, two lounges, a conservatory and a smokers lounge. The first floor houses 15 single rooms, 2 bathrooms, one shower room and two separate toilets. The second floor has the remaining 14 bedrooms, two further bathrooms and two separate toilets. In November 2006, the weekly fees were between £475 - £515 dependent on the level of care needs. Additional charges were made for hairdressing, chiropody, etc. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Friday 8th December 2006 between 09:30 and 16:30. Before the inspection, Mrs Thornhill, the manager, had provided information about the management of the home and the basic care needs of the residents. The residents and visitors to the home were invited to complete comment cards giving their view of the service provided. Responses were received from 26 residents, 5 GPs and 15 relatives. The responses showed very high levels of satisfaction although two people did comment on the standard of the food offered. During the visit, the inspector spoke with residents, staff and visitors; further information was gained from a tour of the premises and examination of records. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well:
The survey cards received prior to the inspection showed high levels of satisfaction, comments made included: “I like living here” “…good humoured staff are helpful and patient” “High standard of care and activities” “A well managed home with caring and well informed staff who communicate well with us” “Absolutely delighted with the care our relative receives” “I would recommend Queensmead to others.” The home provides new residents and their carers with a welcome pack giving them information on the services provided by the home and the fee structure. The records seen showed that they had signed a contract either by the resident or their representative. No resident is offered a placement until the home has determined if it can meet the needs of the individual. The assessment included any religious and cultural needs. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 6 Care plans were in place and there was evidence of reviews and risk assessment. The home worked closely with community healthcare teams to ensure that health needs were met. Medication in the home was managed by senior staff who had been trained and assessed as competent. Medication was safely and securely held. The activity organiser posted a weekly programme; it showed a variety of group activities and included time for one to one work. Residents said they enjoyed the activities but there was no compulsion to join in. During the summer, several residents had enjoyed the excursions. The home had a system for recording and responding to complaints. One resident said that a complaint she had made had been handled well by the senior staff. The staff received training in responding to allegations and signs of abuse, they were aware of their obligations and responsibilities and had been given copies of the General Social Care Council’s Code of Conduct. The home was warm and comfortable. The bedrooms seen had been personalised by the occupants. Residents said the home was kept at a comfortable temperature throughout the year. The staff were seen using aprons and gloves and had been trained in infection control. Staffing levels were appropriate to the needs of the residents. The reliance on agency staffing had reduced following recruitment of permanent staff; this had improved the continuity of care for the residents. The organisation’s training programme was accessible to the staff and helps the staff to develop and maintain their caring skills. Queensmead benefits from an experienced management team. The organisation also carry out their own internal checks to monitor the standards in the home. Residents felt that they were given various systems to allow them to express their views on the running of the home. Reports and minutes from meetings confirmed their involvement in how the home was run. Staff were not involved in financial management for any of the residents, however, most people had cash deposited with the staff for personal expenditure. A sample showed the records of transactions were up to date and matched the balances held. There were internal checks to ensure that any accounting errors were detected and remedied quickly. Visitors said the system worked well. What has improved since the last inspection?
During previous visits the residents have commented on the poor standard of food provided in the home. During that time the management had introduced several quality control initiatives including sampling the meals served. Although two negative comments were received regarding the serving
Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 7 temperature of the meals and the way the vegetables were cooked the remainder of the residents were extremely positive about the standard and choice offered. The home continues to monitor the meals provided and seeks the views of the residents’ after each meal. The communal areas had been refurbished and there was new flooring in the dining areas. Records showed that fire drills take place to ensure staff and residents were able to practice evacuation procedures and this was confirmed in the discussion with staff members. What they could do better: 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.
Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 8 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 Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides clear information to prospective residents and their carers about the services offered in the home; allowing the individuals to make informed choices. Contracts give detail to the residents, or their representative, about the fee structure and conditions applying. The assessment process helps to ensure that the home only offers placements to people whose needs can be met in Queensmead. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 10 EVIDENCE: During the visit four, recently admitted, residents were case tracked. The records showed that the home had carried out assessments in order to determine that the home was able to meet the care and social needs of the individual. There were copies of the confirmation letters, including the funding arrangements and signed contracts for each person. The pre- admission assessment were normally completed before admission, however, in the case of one resident who had transferred to the area the assessment was completed by contact with the resident, their family and the original home. Social Services care plans were also seen on some of the files. One person had visited the home previously for respite care and so was aware of the services provided. The records also showed that information about the services provided was given to the residents. In one empty room there was a copy of the welcome pack which contained the information given to new residents. A service users guide was available to all the residents and there was an information board inside the front door. In discussion with the four residents and one visitor, none could recall the admission process. Each recalled that they had been helped by family and friends and one visitor confirmed that he had visited Queensmead and other homes before deciding to accept the placement. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home develops care plans to identify any changes in care and social needs to ensure that the care tasks meet those identified needs. The health needs of the residents are met through support from community healthcare teams. For the safety of the residents the home’s medication was safely stored and managed. People were treated with dignity and respect in order to protect their basic rights. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 12 EVIDENCE: The records seen contained care plans and risk assessments based on the preadmission assessment and care reviews. The care plans showed good level of detail and there was evidence of regular reviews being completed, however none of the files showed the involvement of the residents in the care planning, risk assessment or review processes. The files seen showed that social histories, including any spiritual or religious needs, were considered during the admission and review process. The records showed that the home had made appropriate referrals for community healthcare services. Five GPs responded to the comment cards all gave a positive response and none had received complaints about the home. Weight charts were in place to help monitor any significant weight changes. Residents confirmed that the staff arrange GP visits as needed. The home’s medication was safely and securely held. Staff were distributing the lunchtime medication, the member of staff was being supervised by the shift leader as part of the training process. The records seen were up to date and contained information on allergic reaction to medication. There were photos on file to aid identification. Temperature sensitive medication was stored in a secure fridge and the maximum and minimum temperatures were monitored to ensure the fridge was working at the correct temperature. The comment cards from the residents and visitors identified that they received good support from the staff in the home. This view was echoed by the residents and visitors seen during the visit. The staff were observed supporting and treating the residents with dignity. There was a friendly rapport between the residents and staff. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes residents’ choice in order to encourage the residents to maintain as much independence as their circumstances allow. The menu offers a good variety of items to help to promote a balanced and nutritious diet. EVIDENCE: The home employed an activity co-ordinator for weekday mornings. The activity programme was posted in the hallway. Residents have the option to join in a range of group activities and the coordinator also carries out one-to-one sessions for those who prefer it. Some residents have daily newspapers and several enjoy completing the crosswords. One person said she appreciated the library service operated in the home. Spiritual needs are considered during the admission process and the residents
Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 14 are invited to monthly church services held in the home. Residents said that the home celebrated birthdays with cards and cake. People said that the home did not have excessive rules and that they were able to exercise a fair degree of choice in their daily lives. One person said that she was an early riser but also liked to go to bed quite early and this was not a problem. Another person said she did not sleep well and said that the staff would bring her a cup of tea on request. Another commented that during a recent spell of ill health a member of night staff had spent time with her chatting and helping to make the night pass quicker. Visitors to the home said that the staff welcomed them at any time and they were usually offered refreshments. The comment cards received were generally very positive however as with previous inspections of the home two people commented on the poor quality of the food served. It should be noted that others were very complimentary about the standard of food provided. One person said that the food was very good but like when she cooked for her family sometimes things were not as good as they should be and that was to be expected. The home had worked hard to address the issues; there is a new chef and assistant chef both were keen to provide suitable food. The menus were developed through feedback from the residents meetings and senior staff carry out daily sampling and seek the views of the residents. The menu offers a choice of two main dishes with alternatives of salads and omelettes always available. The sweet trolley offers an excellent choice of sweets with fresh fruit also offered. The daily menu is displayed on the notice board in the dining room. Residents can opt to have their meals in their rooms however; they preferred to go to the dining room. The chef prepares homemade cakes and the one tried during the visit was very tasty. In discussion with the assistant chef he could identify those people with special diets and how those needs were to be met. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to allow residents to raise concerns and for staff to respond to allegations or signs of abuse. EVIDENCE: The welcome pack provided to all new residents contained the complaint procedure. It was also posted in the main lobby to make it available to any visitors. None of the GP’s had received complaints about the home. The home maintained a record of complaints and compliments. No complaints had been recorded since the last visit and the Commission had received no concerns. The residents seen during the visit said they were able to raise concerns directly with the staff or management. They were also able to raise common issues within the residents meeting; minutes of the meetings were posted on the notice board. One comment card stated that a resident had raised an issue and that the staff in the home had acted promptly to satisfactorily resolve the issue.
Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 16 The staff cover adult protection procedures during their induction training. The staff spoken to were aware of their responsibilities and how to access the relevant procedures. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the residents and staff with a safe, clean and comfortable environment. EVIDENCE: The home had recently been refurbished with the ground floor hallways being redecorated and re-carpeted. There had been new laminate flooring in both dining rooms. The main areas were decorated for the Christmas celebrations. The bedrooms seen had been personalised by the occupants. The bedroom doors were fitted with appropriate locks to allow for privacy while remaining accessible to staff in the case of an emergency. All rooms on the first and second floor had restrictors on the windows; those seen operated correctly.
Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 18 The building was warm and comfortable. One person said that she had recently had her own mattress brought in and now felt more at home. There was evidence of protective gloves and aprons in use around the home used to help manage infection control. Soap dispensers and paper towels were provided in each of the bathrooms and toilets. In one toilet on the ground floor the soap dispenser was not fixed to the wall, Mrs Thornhill said the matter would be addressed promptly. The laundry was sited well away from the food preparation and storage areas. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was appropriately staffed to meet the needs of the residents The organisations induction and training programme helps to ensure the staff have the relevant skills. The recruitment procedure provides a robust procedure for the appointment of staff, however the process was not always fully followed within Queensmead. EVIDENCE: There had been a relatively high turnover of staff the reasons for this were explained by Mrs Thornhill. They had worked hard to reduce reliance on agency this had resulted in an increase of overseas staff. There command of English was considered during the recruitment process to ensure that the residents’ needs would be understood. There were no residents in the home whose first language was not English. Staffing levels were appropriate to the needs of the residents. At night two wakeful carers and a Care Team Manager, who sleeps in, staff the home. During the previous night shift, the CTM was called twice but normally the shifts were described by the staff as manageable.
Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 20 The organisation operates a thorough recruitment procedure and no one starts work without a Protection of Vulnerable Adults check and an application for a Criminal Records Bureau clearance. The records seen showed the system was generally well managed. However, on one file it was noted that the personal references had not been returned and there had been no apparent follow-up; this could allow someone deemed unsuitable working in the home. The organisation has a comprehensive training programme which is accessible to the staff through the supervision process. The programme includes core and specialist subjects; seven staff had completed NVQ level 2 award in care and another 3 were part way through and another nominated to start in the New Year. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 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 managed with external checks to ensure that the residents’ views and wishes are upheld. The home’s policies and procedures help to protect the residents from the risk of financial abuse within the home. Appropriate health and safety systems help to manage risks for the residents and staff. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home’s senior staff have very good levels of experience gained over several years managing the service. The organisation carries out monthly visits to the home to ensure that the standards are maintained; the resulting report is shared with the manager and the Commission. Residents had the opportunity to feedback there views on the home through quarterly meeting, the minutes an actions were posted on the notice board. The records of the meeting showed that the issues raised were taken seriously and any action to resolve the problem was noted. The organisation undertakes an independent annual quality audit and seeks the views of the residents, staff and visitors. The reports show continued high levels of satisfaction and the results used to identify areas for continuous improvement. The home also has a suggestions box however none of the residents spoken to had used it. As previously stated the senior staff carry out daily reviews of the food and seek the views of the residents on the quality and choice offered. The home looks after personal allowances for most of the residents a check of the records and balances held showed that there were checks in place to quickly remedy any errors. One visitor to the home said that they preferred to manage the allowances as they were regularly visitors and this had not presented any problems. The staff did not manage the finances for any of the residents. Records showed that fire safety systems and training were up to date. During the tour of the premises, hoists and lifting bath seats had been serviced during September 2006. There was no hazardous cleaning material left unattended. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 23 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 2 3 Refer to Standard OP7 OP26 OP29 Good Practice Recommendations The home should ensure that the resident, or their representative, have been involved in the care planning and risk assessment process. The soap dispenser in ground floor toilet should be refixed to ensure that staff have easy access to hand washing facilities. Two references should be obtained before the appointment of all new members of staff. Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Queensmead DS0000026862.V323327.R01.S.doc Version 5.2 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!
