Inspection on 24/08/06 for Rosewood House

This inspection was carried out on 24th August 2006.

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

Rosewood House 27/02/06

Rosewood House 31/08/05

Rosewood House 06/02/05

Rosewood House 08/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Rosewood House 55 Westbury Road Westbury On Trym Bristol BS9 3AS Lead Inspector Vanessa Carter Key Unannounced Inspection 24th August 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 Rosewood House DS0000026515.V305931.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. Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosewood House Address 55 Westbury Road Westbury On Trym Bristol BS9 3AS 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) 0117 9622331 0117 9691973 sam.hawker@blueyonder.co.uk Ablecare Homes Miss Rebecca Louise Kingston Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 17 persons aged 65 years and over, requiring personal care. 27th February 2006 Date of last inspection Brief Description of the Service: Rosewood residential care home is registered with the Commission for Social Care Inspection to provide accommodation and personal care for 17 service users aged 65 years and above. The home is located in a residential suburb within the city limits and the accommodation is arranged over three floors. The property has been adapted to meet the needs of the residents with a chair lift providing access to rooms on the upper floor. There is level access out into the well-kept rear courtyard. Accommodation is offered in single rooms with six of the rooms having patio doors leading out into the rear garden. Although registered for 17 persons, the home accommodates only 16 persons. The home is one of a group of four homes owned and operated by Ablecare Homes; the business is owned and operated by the Willcox family. The registered manager is Miss Rebecca Kingston. The cost of placement at the home is between £400-535 per week and is dependent upon assessed need. Additional costs are made for a range of services and these are detailed in the Homes Brochure. Prospective residents are able to find about the home by requesting a copy of this from the Home Manager. Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over 6 hours and was completed in one day. The manager was present during the inspection and participated in the process. Evidence was gained from a whole range of different sources, including: • Information provided by the manager in the pre-inspection questionnaire • Information taken from resident survey forms • Directly speaking with residents • Case tracking a number of residents • Speaking with care staff • A tour of the home • Examination of some of the homes records • Observation of staff practices and interaction with the residents. The overall analysis is that the home is a good place in which to live and to work. What the service does well: What has improved since the last inspection? Following the last inspection in February, four requirement notices were issued and the home has shown compliance in each area. The whole staff team have received training in safeguarding adults issues, there is a new induction training programme for new staff members, the one identified carpet has been correctly fitted, and proper signage is displayed where oxygen cylinders are stored. All these improvements mean that the resident’s safety is enhanced. Rosewood House DS0000026515.V305931.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. Rosewood House DS0000026515.V305931.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 Rosewood House DS0000026515.V305931.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, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes assessment processes and the information available about the home ensures that placement is offered to those people whose needs they can meet. EVIDENCE: No changes have been made to the statement of purpose and homes brochure, since the last inspection and both contain all information as detailed in the National Minimum Standards. The documents are available in the home, along with the previous inspection reports. Each resident is provided with a statement of terms and conditions upon admission “Residents Contract”. The four residents who returned the survey forms to CSCI, stated that they had been provided with information about the home prior to moving in and that they had been given a statement of terms and conditions (a contract). Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 9 The manager visits any prospective resident, so that an assessment of their needs can be made. Placement at the home is not offered to any person whose needs cannot be meet. The home has had a number of admissions in the last month and the pre-admission procedures were examined. One resident commented on the survey form that they had had a “pre-admission visit” to the home and that an assessment of their needs had been completed. Documentation evidenced that an assessment had been undertaken prior to placement being offered and arranged. Where appropriate, health needs assessments and social services care plans had been obtained. Assessments by the manager were seen on file. Placements are arranged on a month’s trial basis with a review taking place at the end of this period with all necessary parties. Prospective residents are invited to visit the home prior to taking up residence. Rosewood House DS0000026515.V305931.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. The homes care planning processes and medication procedures mean that residents can be assured their personal and healthcare needs will be appropriately met. EVIDENCE: The care planning files for four people were looked at, including the file for one person who had recently moved to live in Rosewood. Each persons care needs are looked on an individual basis, with detail recorded of how these needs were to be met. The home records an overall objective of the care plan, the options explored, and the views of the service user and carers. Residents spoken to confirmed that they were involved in the care planning process and that they were well looked after. Where possible the resident had signed their agreement to the plans. There was evidence that the plans had been reviewed on a regular basis and been updated where necessary. Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 11 The home maintains a record of any visits by healthcare professionals. The district nursing services are regular visitors to the home to assist with dressing and blood tests. Other healthcare visitors include chiropody services, dentists and opticians. Where possible residents are supported to retain the services of existing services, if this is what they choose. GP’s are asked to visit a resident whenever there is a need rather than on a planned basis. Residents confirmed they were happy with the standard of care provided and felt they were well looked after. A look at the homes procedure for ordering, receipt, storage, administration and disposal of medications, evidenced good and safe working practice. The home have obtained official oxygen signage to display when oxygen is being used in the home. Residents are cared for with respect to their dignity and their privacy. Personal care is provided in private and staff were observed to knock on doors before entering a room. Each of the residents were nicely dressed and their clothes were well cared for. During the course of the visit, all the staff were observed interacting well with the residents, being friendly and attentive. One of the staff helped a resident with their hearing aid and despite the task taking a long while to resolve, the worker remained attentive till the aid functioned correctly. Rosewood House DS0000026515.V305931.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. Residents are able to participate in a range of meaningful activities and spend their time as they wish, and are provided with well balanced and nutritious meals. EVIDENCE: The home arranges a variety of different activities for the residents, and they are able to choose whether to participate or not. Examples include quizzes, music sessions, and painting. The hairdresser visits each week. External entertainers are booked each month and in July the home had a garden party. There is a planned trip to the Zoo in September. One resident commented on the survey form that “I like the musical entertainment but not the games”. One resident said that they liked to keep busy and loved looking out for the other residents. Residents confirmed that they are able to go out for trips with their relatives. Some residents go out to local clubs to maintain contacts with old friends and to continue with favourite pastimes. Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 13 Some of the residents were in the lounge area; some were in the dining room, whilst others had remained in their bedrooms. One resident said she liked the peace and quiet of her room but liked to come down for meal times. It is evident that the residents are able to choose where they like to spend their time and most were seen to be moving independently around the home and out into the garden. The home has an open visiting policy and visitors are able to visit at any reasonable time of day. They are asked to sign in at the visitor’s book. One person said they have a daily visitor. On the day of inspection the lunchtime meal was gammon and pineapple, with swede, green beans and potatoes. Two residents had an alternative and confirmed that a choice is always available if they don’t like the meal on offer. There is a choice or several snack meals in the evening. One resident said “we are very well fed”. The meals are served “restaurant-style” but the residents are able to help themselves to second helpings if they want. One resident was joined by one of their relatives for the midday meal. Rosewood House DS0000026515.V305931.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. Residents can be assured that any complaints they have will be listened to and acted upon and that they will be safeguarded from harm. EVIDENCE: The homes complaints procedure is included in the homes statement of purpose and is displayed in the main reception area. Residents spoken with during the course of the inspection said they would talk to the staff if they were not happy about anything. The home has received one complaint in the last 12 months, and this was also referred to CSCI and the local authority. The investigation is still ongoing. Residents spoken with during the inspection said that there was nothing to complain about but if they needed to they would ask to speak to the manager. Residents said that the staff are always helpful. The home has policies and procedures in place to ensure that the residents are safeguarded from any form of abuse. All staff have attended adult abuse awareness training delivered by the Bristol City Council. A copy of the homes policy about the protection of vulnerable adults (POVA) is kept with all other policies and procedures and is displayed on the staff notice board. Staff spoken with during the inspection demonstrated a good awareness of adult abuse issues and of their responsibility in reporting any bad practice. Rosewood House DS0000026515.V305931.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. Residents live in a home that is generally safe, comfortable and well furnished. One carpet needs to be replaced. The home is warm, well lit and is kept clean and tidy. EVIDENCE: Rosewood House is located in a suburban area of Bristol adjacent to the wellknown Durdham Downs. It over looks the playing fields of the Badminton School and is round the corner from local shops and other amenities. The living accommodation is arranged over three floors, and a central stair lift enables those residents with impaired mobility, to access the whole home. The home is well maintained throughout, comfortably furnished and tastefully decorated. Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 16 The communal areas are all located on the ground floor. There is one large lounge at the front of the home, and one dining room at the back of the house. The kitchen leads off from the dining room, and also the corridor leading to the manager’s office, a bathroom and the five courtyard bedrooms. There is a very pleasant courtyard garden to the rear of the property and this is easily accessibly by the residents. At the centre of the yard is a large fishpond and this is covered with netting. Areas of the garden provide shaded areas for the residents to sit in, and colourful hanging baskets surround the edges. There are toilet and bathing facilities located throughout the home, in sufficient numbers to meet the needs of the residents. The home have fitted door alarms to some of the bedrooms of those who may wander. If their bedroom doors are opened during the night, staff are alerted to this. The home has a stair lift and grab rails and assisted baths are fitted. The manager explained that each resident is assessed for his or her ability to use the stair lift independently. One resident said they did not like to wait for assistance but recognised that they needed the help. Each of the resident’s bedrooms have en-suite facilities – some have just a toilet and wash hand basin, whilst others have a full bathroom. Each bedroom reflects the resident’s personal taste. The individual rooms were well furnished and homely, but the carpet in one room needs to be replaced as it is old and uneven. In addition the carpet covering the step leading into another room needs to be secured properly. The home was warm, well lit, clean and tidy, and free from any malodour. The four residents who completed the survey form said that the home was always or usually “fresh and clean”. Rosewood House DS0000026515.V305931.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. Residents are cared for by skilled staff that are trained and competent to meet their care needs. EVIDENCE: The staffing levels at the home are appropriate to meet the needs of the current residents, many of whom are still fairly independent. The staff rota’s show that each morning there are two care staff, two in the afternoon and evening, and over night one waking member of staff and one sleeping night staff. On the day of inspection there was additional staff working in order to escort a resident for a hospital appointment. This evidences that the home adjusts the staffing levels to meet resident’s needs. The home has designated staff for catering and domestic duties, and Ablecare homes have a maintenance team who cover the four homes. The manager is included in the care staff numbers but has supernumerary hours to complete administrative duties, including the supervision of staff. Staff spoken with, were enthusiastic and able to demonstrate a good awareness of each of the residents specific needs, their likes and dislikes. Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 18 The home currently has only one member of staff, in addition to the home manager, who is trained to NVQ level 2 (12.5 ), but four are working towards achieving the award (62.5 ). It is not expected that these four will complete the course until next year. The home should continue to commit to the NVQ training programme to ensure they meet the 50 target. The home has previously demonstrated that they follow robust recruitment procedures to ensure they employ the right people for the home, but since the last inspection have not recruited any new staff. Recruitment procedures include the completion of an application form, attendance for an interview, two satisfactory written references, and CRB and POVAfirst clearance, prior to employment. The home is to introduce a new induction - training programme for staff and this is in line with the Skills for Care specification. It is expected that the new recruit will have completed the programme within the first 12 weeks of employment. As part of this programme they will be assessed as competent in Manual handling, Health & Safety, First Aid, Protection of Vulnerable Adults and Food Hygiene skills. The home has a training plan for 2006 that includes all the mandatory training courses plus others of a specific health nature. The training files contained copies of certificates of attendance on courses. The manager explained that all staff are to have manual handling refresher training – this will be provided by one of the other Ablecare home manager’s who has received the relevant trainer training. Rosewood House DS0000026515.V305931.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, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well managed and run in their best interests. The home is safe and their health, safety & welfare is promoted and protected. EVIDENCE: The home manager, Rebecca Kingston has been in post for approximately 18 months, and is in the process of completing the Registered Managers Award. . She is hoping to have completed this by the end of the year. The manager was cooperative during the inspection process, demonstrated a good awareness of the resident’s needs and the qualities of the staff team, and evidenced her competence in the management of the home. Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 20 Observations of the working practices, and the interactions between manager, residents and staff, evidenced that the home is run in the resident’s best interests, their views are important, that they are listened to and any concerns are acted upon. Ablecare Homes completed a ‘customer service satisfaction’ questionnaire survey in April and the results showed that in general the residents were happy with the service received. The survey covered meals, choice of activities arranged, home arrangements, involvement in care planning and ability to express any concerns or complaints. The director completes monthly reports for CSCI, visiting the home on a regular basis and monitoring the standards of resident and staff satisfaction and dealing with any management issues. The home holds monies for a number of residents. An examination of the accounts for a sample of residents were checked and tallied with amounts held. An examination of the staff supervision records evidenced that all staff receive 1:1 supervision with the manager at least six times per year. It is evident that there is a high level of support from the manager on a day-to-day basis. The homes standard of record keeping is good and information or written records, requested during the inspection were readily available. The home’s records are kept securely in the manager’s office. The home must ensure that notification to CSCI of significant events that occur in the home (known as reg 37’s) is made “without delay”. The home have on occasions taken up to seven days to notify CSCI of such events. The home must also ensure that all records regarding the residents are maintained in the property, at all times. A complaint has been made that records regarding an accident that had happened, were not in the home, but instead where kept in the head office. This complaint was upheld. Policies and procedures are in place to ensure that both the residents and staff health, welfare & safety are promoted. Staff are requested to sign to acknowledge understanding of the policies and procedures. The home has devised an effective system for staff to report any maintenance and repairs that are required. All the necessary environmental checks were completed. There was evidence that staff had been instructed in the homes fire safety procedures and the fire alarm system. All the health and safety testing of electrical equipment, stair lifts and hoisting equipment were up to date. The fire log showed that regular fire drills have been performed at various times of the day, and that all the staff have been included at some time or another. The home was well maintained throughout by the Ablecare Homes maintenance team. Rosewood House DS0000026515.V305931.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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 3 3 3 2 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 3 3 X 3 3 2 3 Rosewood House DS0000026515.V305931.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 OP24 Regulation 16(2)(c) Requirement The one identified bedroom carpet should be replaced The carpet on the identified step should be properly secured 2. OP37 17(2) The accident records must be retained in the home and available for inspection. Notification of deaths, illness and other events must be made to CSCI “without delay” 24/09/06 Timescale for action 24/09/06 37 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 OP38 Good Practice Recommendations Regulation 37 notifications as referred to above, must be made to CSCI within 48 hours. Rosewood House DS0000026515.V305931.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Rosewood House DS0000026515.V305931.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. 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. 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