Inspection on 10/09/07 for Sandtoft

This inspection was carried out on 10th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sandtoft 04/01/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Sandtoft 70/72 Alderley Road Hoylake Wirral CH47 2BA Lead Inspector Julie King Key Unannounced Inspection 12:30 10 September 2007 th 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 Sandtoft DS0000067373.V346054.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. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sandtoft Address 70/72 Alderley Road Hoylake Wirral CH47 2BA 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) 0151 632 1952 Sandtoft Care Home Ltd Mrs Yvonne MacDougall Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2007 Brief Description of the Service: Sandtoft is registered to provide personal care to 22 older people. The home is a three-storey building with access via stairs and a passenger lift to all floors. There are 22 single bedrooms 16 of which have en-suite facilities. Five rooms are of double room size. Communal facilities comprise a lounge, dining room, conservatory and a quiet library area. Two bathrooms and a shower room are provided and assisted bathing facilities are available. There is a ramp access to the home for wheelchairs or residents who cannot manage the steps to the front of the building. The home is situated in the residential area of Hoylake close to the beach and promenade. Access to public transport and the centre of Hoylake is close by. Fees at Sandtoft range from £347 (local social services rate), depending upon the room occupied. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of a key inspection, this site visit was conducted over one day; during which a short tour of the premises took place, and staff and care records were examined. The deputy manager accompanied the inspector throughout this visit. All staff on duty plus some residents were spoken to during this visit. There were no relatives present during this site visit, but questionnaires have been sent out by CSCI to obtain their views on the service. What the service does well: What has improved since the last inspection? What they could do better: The management, quality assurance, staffing levels in the afternoon, communication and all records pertaining to staff and residents need improvement to ensure the home is run in the best interests of the residents. Policies, procedures and practice are not reviewed regularly or kept up to date, and quality assurance monitoring is not implemented as a core management tool. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sandtoft DS0000067373.V346054.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 Sandtoft DS0000067373.V346054.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents needs appear to be met, and the home is able to provide assurances to residents that most of their future needs should be catered for. EVIDENCE: The manager has produced a Statement of Purpose that is specific to the home and the resident group they care for, which sets out the objectives and philosophy of the service, supported by a Service user Guide. The guide details what the prospective resident can expect and gives an account of the services provided, the accommodation, qualifications and experience of staff, and how to make a complaint. However neither of the guides seen evidenced all the required information and it was suggested to the deputy manager that this information be kept together, rather than in separate places. New residents are provided with a Statement of Terms and Conditions/Contract; this sets out in detail what is included in the fee, the role Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 9 and responsibility of the provider, and the rights and obligations of the individual. This gives a clear understanding of what residents and their relatives can expect. Admissions are not made to the home until a needs assessment has been undertaken. For people whom are self funding and without a Care Management Assessment, the assessment is always undertaken by an experienced member of staff, usually the registered manager. The assessment involves the prospective resident, and to a lesser extent, their family or representative where appropriate. If the assessment has been undertaken through care management arrangements the manager obtains a summary of the assessment and a copy of the care plan from the liaising social worker. Since the previous site visit there has been a change in the documentation being used for pre-admission and care planning records. The recently implemented records do not evidence that holistic assessments are recorded on all files. If this evidence is not available for all staff, there is the potential that all the residents’ needs might not be identified thoroughly. Prospective residents are given the opportunity to spend time in the home as either a trial visit, or just a look around and a chat with the current residents. Residents spoken to said that they “had met someone” from the home prior to admission, and that “my son was involved” during this process. Standard 6 was not assessed as this home does not provide intermediate care. Sandtoft DS0000067373.V346054.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is adequate. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a basic care planning system in place for all residents. This provides staff with some of the information they need to meet the residents’ needs. EVIDENCE: A number of residents’ care plans and associated records were examined as part of the case tracking process. All the files seen evidenced that the residents have access to health care services both within the home and in the local community; and the majority of residents are able to choose their own GP and attend local dentists, opticians, etc. Documented evidence showed that health needs are monitored, albeit irregularly, with some monthly reviews, including important risk assessments, such as for nutrition, last completed in May 2007. The home is generally able to provide the aids and equipment needed by the residents, but more attention Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 11 should be given to each residents’ changing needs as they happen, and all related care documentation should be updated accordingly, as claimed in the home’s Statement of Purpose (“four weekly reviews”. There is some evidence in the care plan of health care treatment and intervention, and a record of general health care information. There are some gaps in information but staff are able to think in a person centred way and are able to give a verbal update of each resident. The staff encourage residents to be as independent as possible, and to take responsibility for their own personal hygiene, with assistance if necessary. The views of residents are sought in the way personal care is delivered, and it was observed that staff clearly had a good rapport with all the residents and relatives seen during this site visit. The manager has a medication policy which is accessible to staff, and medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. There is evidence of some people administering their own medication safely. The staff understand the need to comply with the administration, safekeeping and disposal of controlled drugs, but do not always follow good practice or safe practice guidelines, and numerous gaps were seen in the controlled drug register. Also a number of prescription only medications were seen left out in the manager’s office (mainly inhalers). Staff spoken to think in a person centred way when considering an individual’s personal care needs, and appeared aware of the need to treat individuals with respect and to consider dignity when delivering personal care. Residents spoken with said that they “are happy” with the way that staff deliver their care and respect their dignity, and they “could talk to the girls at any time”, and that “I am asked about what I want”. The home has policies and procedures, which provide guidance for staff on how to support a person and their family when faced with a terminal illness. The wishes of individuals about terminal care and arrangements after death is not always recorded, and staff are not consistently trained in terminal care but are able to give a verbal account of good practice. Sandtoft DS0000067373.V346054.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The choice and delivery of activities is adequate which help support residents’ lives. Meals in Sandtoft are good, offering choice and variety, and cater for residents’ special dietary needs. EVIDENCE: All staff spoken to were aware of the need to support residents to develop their social, emotional, communication, and independent living skills. All residents are consulted and listened to regarding the choice of daily activity, but the choice and availability of activities has reduced recently due to the activities co-ordinator wishing to relinquish her role. This, coupled with only having a senior member of staff on duty with one care support worker cannot and does not provide sufficient staff hours to give all residents the time and choice over their daily activities. The staff are very dedicated and hard working and do try to get information on community based events and try to make individual arrangements for residents to attend. Birthdays and special occasions are celebrated for all residents, and their families are invited and encouraged to take part. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 13 Policies, procedures and guidance promote individual independence and the right to live in a flexible environment where their choice of routines and activities are met when possible. Systems for checking practice are not always evident. The home tries to be flexible and attempts to provide a service that is as individual as possible using its staff and resources effectively. Not all people who use services are consulted on how the home can work to provide them with a flexible lifestyle, the home recognises this and plans to make some changes. The food reflects the residents’ likes and dislikes, and special diets are catered for. All staff handling food have an up to date Food Hygiene certificate. Sandtoft DS0000067373.V346054.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaint and adult protection policy and procedure was in place that helps ensure the safety and welfare of residents. EVIDENCE: The manager has an open culture that allows residents to express their views and concerns in a safe and understanding environment, and has a complaints procedure that is clearly written and easy to understand. The complaints procedure is available to all residents and their families, and is displayed in a number of areas within the service, but does not have the current CSCI contact details on it. Residents appear to understand how to make a complaint and are clear about what will happen if a complaint is made. Residents spoken to said they could “talk to the girls if there was a problem”, and another said, “I’ve no complaints, its good here”. The home keeps a record of complaints and this includes basic details of the investigation and actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The Wirral policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. All staff spoken to said they knew when incidents need external input and who to refer the incident to, and an accessible list of contact numbers is available for help and advice if needed. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 15 The deputy manager understands the procedures for Safeguarding Adults and will provide information to external agencies when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. Training of staff in the area of protection is arranged and other training around dealing with verbal aggression is also made available to staff if needed. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 16 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): 19,20,21,22,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All of the residents’ rooms are personalized, providing the residents with a homely place to live. EVIDENCE: Sandtoft provides a physical environment that meets the specific needs of the residents who live there. The home is comfortable and has a programme to improve the decoration, fixtures and fittings; and all residents can personalise their rooms as they wish, and said that they can have some input into the décor. Some en-suite facilities are available, and there are sufficient communal bathing areas that meet the needs of the residents, but the manager must ensure that no communal toiletries are left in bathroom cabinets at any time. Toilets are appropriately located within the home, are easily accessible and in sufficient numbers. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 17 The front and rear gardens are well maintained and provide a pleasant place for residents and their families to enjoy in the warmer months. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. There is a consistency of care within the home provided by longer serving staff, which helps to offer safety and stability for the residents. EVIDENCE: Staff rotas show that the home is not staffed efficiently, with some attention given to busy times of the day and changing needs of the residents. The staff are very hard working, but cannot be in two places at the same time. This was clearly evidenced during the site visit when residents were having to wait for rushed, but kind, assistance from the staff who were very busy. One resident had an accident that required hospital admission but there was no free member of staff to accompany the resident in the ambulance, and reliance was placed on the family to meet the resident at hospital. This unacceptable practice is not the fault of the staff, and the provider and manager must take steps to ensure that at all times there are sufficient staff on duty for the health, safety and welfare of all residents. Staff members undertake some external qualifications beyond the basic requirements, and the manager encourages and enables this, recognising the benefits of a skilled, trained workforce, and the home can boast of a high level of NVQ 2 trained care staff. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 19 Job descriptions and specifications define the roles and responsibilities of staff. Residents spoken with said that the “staff are nice”, and “the staff are very good in here”. These comments are supported by the numerous letters of thanks and appreciation from relatives, which were seen on the notice board. Four of the recently employed staff’s personnel files were examined, and none of them evidenced all the required documents and records, including work permits (if required). The recorded inductions were basic in detail. It is essential that all staff are thoroughly inducted into their new roles so they can practice in a safer manner and have a better understanding of their roles and responsibilities under relevant health and safety, and other relevant legislation. The manager has a ‘company’ recruitment procedure that defines the process to be followed. This procedure is not followed in practice. The service must now recognise the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individual residents. Staff meetings and supervision sessions do happen; and staff said they find these sessions “useful”. Notes are taken of meetings and sessions and recorded in each staff’s personnel file, but it is suggested that supervision records contain evidence of other aspects of staff supervision, rather than just observation and notes of daily tasks. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 20 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): 31,32,33,35,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This home has an established staff team, thus helping to improve the quality of care given to residents. EVIDENCE: The manager is registered with the CSCI, and has the support of a experienced deputy managers for assistance with the day-to-day running of the home. This home has deteriorated (especially regarding record keeping) since the previous site visit, and up to date, detailed documented audits and checks of residents’ care files were not available. Training, development and supervision of staff is satisfactory and staff do get leadership from the manager. Policies Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 21 and procedures in practice are not reviewed regularly in accordance with changes in legislation, and quality assurance monitoring is not implemented as a core management tool. Staff do not always know the content and philosophy of the Statement of Purpose, it is not routinely discussed in supervision or during training, possibly due to time constraints. Three residents’ personal allowances were checked and none tallied with the amounts on the balance sheets. This is a serious concern and must be investigated and rectified by the registered person as soon as possible. There was little evidence of ongoing quality assurance, but the registered person is currently in process of collating residents’ questionnaires, and staff meetings are held on an ad-hoc basis. The recording of residents’ accidents and incidents, especially regarding any follow-up or actions taken is not fully compliant with requirements; and does not evidence what actions the staff have taken following a resident’s fall. Records and record keeping in most areas including residents’ monies, care plans, medication records and staff files is not compliant with legislation or current good practice. It is of vital importance that all legal documentation such as those mentioned above, is kept up to date and is completed in accordance with requirements at all times. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 22 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 2 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 4 2 X 2 2 2 3 Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation 4 Requirement That all residents’ actual and potential needs are identified, and plans put in place to ensure that current and changing needs are always met. All residents care plans to include all the required evidence of care needs, regular holistic assessments, and resident involvement. For procedures to be in place that ensure early notification and use of other healthcare professionals, and that referrals are accurately recorded. Medication records are to be completed in accordance with legislation and no gaps are evident on the controlled drugs register at any time. The registered person shall ensure that service users are consulted about the programme of activities arranged by the home and provide facilities for the provision of recreational DS0000067373.V346054.R01.S.doc Timescale for action 30/11/07 2. OP7 15 30/11/07 3. OP8 12 30/11/07 4. OP9 13(2) 12/09/07 5. OP12 16(2)(m) 30/11/07 Sandtoft Version 5.2 Page 24 activities based upon individual needs and interests. Previous timescale of 28/02/07 not met. 6. OP27 18 Adequate day staff are on duty in the afternoon to ensure the health, safety and welfare of all residents. That all records and documents required by current legislation are evidenced in all staff personnel files. Clear evidence of ongoing auditing and continuous improvement in all records and care practices. All monies belonging to residents are fully accounted for in a legible manner at all times. The registered person must ensure that all records required for legislative purposes are kept up to date and accurate at all times. 30/11/07 7. OP29 19 30/11/07 8. OP33 24 30/11/07 9. OP35 20 30/11/07 10. OP37 17 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP3 Good Practice Recommendations Supporting documentation for the statement of purpose and service user guides are readily available at all times. Additional detail is recorded on pre-admission assessments, and just ticking a box with no comment is not used. Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 25 3. OP31 It is strongly recommended that the manager puts into practice the wording in the Statement of Purpose and in the home’s policies and procedures; and familiarises herself with current CSCI requirements and recommendations. Supervision is not just a record of what was seen during a shift observation, but an accurate record of all issues that may affect staff ability to deliver good outcomes for all residents. 4. OP36 Sandtoft DS0000067373.V346054.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Merseyside Area Office 2nd Floor, South Wing Burlington House Crosby Road North Waterloo L22 0LG 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 Sandtoft DS0000067373.V346054.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. 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