Inspection on 23/02/07 for Rivers Street

This inspection was carried out on 23rd February 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rivers Street 08/02/06

Rivers Street 26/10/05

Rivers Street 22/03/05

Rivers Street 20/10/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Rivers Street 44-45 Rivers Street Bath Bath & N E Somerset BA1 2QA Lead Inspector Sarah Webb Key Unannounced Inspection 23rd February 2007 09:30 Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rivers Street Address 44-45 Rivers Street Bath Bath & N E Somerset BA1 2QA 01225 335066 01225 335066 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) www.dimensions-uk.org Dimensions (UK) Ltd Mrs Helen Barbara Spurrell Care Home 14 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (1) of places Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 14 persons with learning disability aged 18 years and over 8th February 2006 Date of last inspection Brief Description of the Service: 44 - 45 Rivers Street is a registered care home managed by Dimensions UK Ltd. The home provides accommodation to thirteen people aged from18 to 65 years and to one named person who is over the age of 65 all of whom have learning difficulties. The property is a Grade 1 listed Georgian building converted from two adjoining terraced houses, with the accommodation over four floors. There are two lounge areas on the ground floor with the main kitchen and dining room located on the first floor. There is one double bedroom on the ground floor with the other twelve being single bedrooms. Two of the bedrooms have wash hand basins whilst the home provides sufficient bathrooms/showering facilities and toilets in the home for the other residents. Both a basement and second floor ‘flat’ offer a self- contained kitchen, while the ‘flat’ also has laundry facilities and a lounge. There are also separate laundry facilities available to the remainder of the residents. It is a short walk into the city centre which provides access to a park, shops, leisure facilities, and transport routes by bus and rail both locally and nationally. There is an attractive rear garden with a water feature, shrubs and seating, which is attended to by staff and residents. There is a sitting tenant on the third floor. Rivers Street DS0000008166.V328604.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 inspection with the focus on assessing the key standards of the National Minimum Standards. At the last inspection carried out in February 2006, there were no requirements or recommendations made. There have been no additional visits during this period. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the individuals living at Rivers Street. The inspection was conducted over 7.5 hours. The inspector had an opportunity to meet with several of the service users who were at home for the day. Discussion was also had with the manager and members of staff. The Commission received 7 completed surveys from families and 8 from service users on their views of the service provided by Rivers Street. These were positive in their feedback. A sample of records relating to the day-to-day running and management of the home were inspected. What the service does well: What has improved since the last inspection? There were no requirements or recommendations from the last inspection. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 6 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. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessed needs and preferences of service users are met and there are processes in place for the review of their care. EVIDENCE: There have no new service users admitted to the home since the last inspection. The service users living at Rivers Street are a long established group having lived together at the home for many years. Service users were observed being supported by caring and understanding staff. It was evident that staff have built good relationships with individuals and this was demonstrated through the staffs’ warm approach when service users and staff were together. Service users were relaxed and confident in the company of the staff. Surveys from both service users and families identified that service users saw Rivers Street as their home. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 9 Findings from surveys received from families also included comments such as –“ we have found Rivers Street to be a very happy home and well looked after by staff” and “ looks after the welfare of residents well.” Other comments received also reinforced that families view the home as a caring place and that good relationships exist between staff and service users. All service users are funded by their local authority and had been admitted to the home through the care management process; care files held copies of care reviews in symbolised format identifying service users involvement in the review of their care. The manager said two service users are also in the process of being assessed by their funding authority. Discussion with staff and examination of care files identified that the home was meeting individuals’ physical, social and psychological needs. The home also involves specialist services through the Community Learning Difficulty Team, to support service users and to advise the staff, ensuring a multidisciplinary approach is practiced. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users care plans set out in detail the action needed to be taken by staff to ensure all aspects of their health, personal and social care needs are met. However all care plans must be reviewed on a regular basis in order to monitor service users changing needs. Service users are supported in making decisions about their lifestyles and also in taking calculated risks in order that they pursue an independent life. There are still some aspects of individuals’ risk assessments that must be expanded and developed further in order to protect individuals in the taking of calculated risks. EVIDENCE: The home supports a person centred approach in the planning of individuals care with care plans produced in a pictorial format. This approach helps ensure service users are involved in the process of identifying their needs and the support required to meet those needs. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 11 Care plans observed contained comprehensive information covering all aspects of individuals’ lifestyle, including physical, emotional, and social needs. A service user recovering from an operation had a specific support plan in place to inform staff how they should be supported. This is good practice. Daily records maintained by staff indicated service users routines, activities and any significant issues; this helps to monitor service users care and identify any changing needs. However, not all care plans seen had been reviewed 6 monthly; the manager said she is in the process of updating information. The home has consultation processes in place in order to seek service users’ views and it was evident when sharing a midday meal with service users that they are confident in expressing their views with the staff team and the manager. The processes in place include house meetings to discuss relevant issues and an external advocacy agency also meets with service users to support them through discussion and specific action if requested by individuals. Risk assessments identified actions taken to ensure the home is safe for service users and staff. Risk assessments demonstrated service users are encouraged to live an independent and fulfilling life and take part in varying activities, however these must be further developed and expanded to ensure service users are supported safely in the taking of risks such as going out alone. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to lead full and active lifestyles and are supported by staff to access leisure opportunities in the community. The home has good relationships with service users families and staff support individuals in keeping in contact with both friends and relatives. Service users rights are respected through the promotion of independence and the daily routines of the home. The meals in the home offer variety and encourage service users to be aware of healthy eating options. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 13 EVIDENCE: Although the majority of service users continue to access differing activities through day services, a variety of employment, and work placements, there are those service users who are expressing that they wish to change these services in order to promote their own individual lifestyles. Three service users have been awarded direct payments so that they can look at alternative opportunities. One person has already employed a support worker, through receiving direct payments, to help them access community resources. They were supported to recruit the support worker through an external organisation. Service users access the local community for shopping trips, shows, church meetings and attend various leisure activities; these include swimming, and recreational clubs. A birthday party was in the process of being organised for a service user with arrangements in place to celebrate this with friends invited to the home. Service users were observed with their involvement in the daily routines of the home. An individual described that they had a day at the home when they carried out household tasks. Individuals are supported with maintaining friendships and contact with families. The staff have known the service users relatives for a long time and promote ongoing communication with them. Surveys received from families were positive in their response and identified that they are always welcomed to the home. The midday meal was shared with the 6 services users who were at home for the day, the 3 staff on duty and the manager. It was evident that the home promotes a healthy eating approach and offers service users a good choice of nutritious and varied meals, whilst respecting their individual preferences and dietary needs. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to lead healthy lifestyles with their healthcare and personal needs being met. Service users benefit from robust measures relating to the administration of medication in order to ensure their health, welfare and safety. EVIDENCE: Service users healthcare files combined with Health Action Plans identified that individuals’ physical and mental healthcare needs are met through regular reviews of medication and support from appropriate professionals. Care files also included information that demonstrated service users have access to the GP, dentist, optician, chiropodist and other health related agencies. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 15 Since the last inspection the home has supported a service user on a 1:1 basis during a stay at hospital following an operation. Staff were involved in supporting this individual on a daily basis, supporting them with all their personal care and emotional needs. It was evident that the staff ensured a high level of care and that the individuals needs were met. This is good practice and to be commended. On their discharge from hospital, an alternative, more appropriate, bedroom was provided by the home in order to meet their physical care needs. The home follows the organisational policy and procedures for the administration of medication, including a homely remedies policy. These outline the protocols for the administration, recording, ordering, and disposal of all medication. It was evident through the observation of records and practice explained by the manager that the home has appropriate systems in place for service users to be administered medication safely. Medication is administered through the Boots monitored dosage system, and is kept secure. Records held were well maintained. Training records identified that staff have completed medication competency reviews. There are appropriate arrangements in place for the administration of medication when service users take social leave. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from robust systems for complaints and protection and can be confident that they will be listened to and that they will be protected from abuse. EVIDENCE: The home follows the organisational formal complaints procedure; service users have been given an accessible copy of the procedure explaining how people can complain. There have been no new complaints recorded since the last inspection. Observation of service users interaction with staff indicated that relationships are positive and warm with open communication taking place for individuals to feel confident in expressing concerns. As previously recorded, the home also has processes for service users to express their views through both house meetings and external support from an advocacy agency. The manager said that service users have used the advocacy agency for raising issues of concern with the Regional Manager. There are organisational policies and procedures in place relating to the issue of protection of vulnerable adults from abuse. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 17 Training records indicated that staff have attended training in the protection of vulnerable adults. The home has also helped ensure the protection of a service user who has employed a support worker independently from the home with their referral to the Criminal Records Bureau. The home has suitable arrangements for the management of service users’ finances. The home has developed specific strategies and instruction in supporting an individual with their finances. Service users finance files record ongoing balances, bank statements and all financial documentation. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and homely environment. EVIDENCE: The property is a Grade 1 listed Georgian building converted from two adjoining terraced houses, with the accommodation over four floors. The home is close to local amenities and is in keeping with all properties in the area. It is a short walk into the city centre which provides access to a park, shops, leisure facilities, and transport routes by bus and rail both locally and nationally. A sitting tenant continues to occupy the third floor. The home is comfortably furnished, is safe and maintains a high level of cleanliness through a cleaner who is employed on a daily basis. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 19 A recent visit from Environmental Health Department identified that the home maintains good practices in line with legislation. The home maintains a log of all repairs reported and the outcome of visits by contractors. The manager said that since the last inspection there has been no redecoration carried out but plans to decorate the top floor flat are pending. Service users were consulted on the use of a second smaller lounge for an individual’s use following an operation and being unable to access their bedroom safely. The manager said the use of the room had not impacted on individuals’ communal space; it was evident that there was alternative sufficient space for service users. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ benefit from clarity of staff roles and responsibilities. The home has robust recruitment procedures in place with service users supported with their involvement in the process. The training needs of staff are sufficiently met. EVIDENCE: Since the last inspection there has been two new staff employed at the home. There are currently 3 fulltime care staff employed leaving 2 posts that are still vacant. The home has also been using both relief staff and ‘outreach’ staff who work at the home on a regular basis. Discussion was had with a new staff member who described their recruitment process, part of which was completion of an application form with two references given, a police check and undergoing a formal interview. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 21 A comprehensive Induction log completed identified all aspects of the running of the home helping them to understand the duties and responsibilities of their role. They indicated that they have been well supported in their new role. On the day of this visit, 2 new short listed candidates were visiting the home to meet and interact with the service users. This forms part of a ‘task orientated’ interview with feedback from those service users involved. The manager said that their formal interview also includes two other service users from the home on the panel. The manager said the views of service users are listened to and if they felt unhappy about any of the candidates they would not be employed. This is good practice and to be commended. Staffing records are kept at the organisational headquarters and there is an agreement in place with Dimensions UK for the Commission to inspect these at periodic intervals. Staffing records were looked at previously, in August 2006. Existing staff are still progressing with completion of National Vocational Qualifications and it was evident that this is an area that will not be completed until the home is fully staffed. Training records identified that since the last inspection, staff have attended mandatory courses in first aid, manual handling, and basic food hygiene. The manager is aware that staff have not had the opportunity to attend any additional training due to shortage of fulltime staff and is hoping this will be rectified with the current vacancies filled. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and staff benefit from a clear sense of direction. There are procedures in place to seek the views of individuals through advocates, staff and families. There are procedures and protocols in place in order to ensure the health, safety and welfare of both service users and staff. EVIDENCE: The manager is continuing to work towards NVQ Level 4. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 23 She is actively involved in changes to the organisation with participation with working groups. It was evident she continues to direct staff towards a person centred approach in supporting individuals and that she has a good knowledge of service users needs. Since the last inspection the deputy manager has left with this post still vacant. The post covered shared hours between the management of the home and care duties. It was evident that this has impacted on both the manager and existing staff. There are organisational processes in place to gain the views of service users. The manager identified a completed satisfaction survey that covered comprehensive areas of service users care and support. These are in symbolised format helping service users to understand and be involved in sharing their views. Dimensions UK also hold differing meetings for service users to attend; an organisational magazine also publishes communication about feedback from the meetings and reports positive changes in individuals’ lives. Records seen have been recorded in the appropriate text of relevant standards; these were well maintained, up to date and securely stored. There are health and safety procedures in place for staff and service users. The manager facilitates fire training for staff and records indicated that all staff were up to date and had both fire training and evacuation. Both agency and existing staff complete fire questionnaires as part of their training to reinforce their knowledge. The fire log identified that appropriate testing of fire equipment had taken place on a regular basis. Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 3 3 X Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 25 NA 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. 2. Standard YA6 YA9 Regulation 15 13(4)(b) Requirement Review care plans on a regular basis in order to monitor service users changing needs. Further develop and expand risk assessments in order to protect individuals in the taking of calculated risks. Timescale for action 30/04/07 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Rivers Street DS0000008166.V328604.R01.S.doc Version 5.2 Page 27 - 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!