Inspection on 27/09/05 for Seymour House

This inspection was carried out on 27th September 2005.

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

Other inspections for this house

Seymour House 14/08/07

Seymour House 13/09/06

Seymour House 25/04/05

Seymour House 19/01/05

Seymour House 19/08/04

Seymour House 10/03/04

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 Seymour House Monkton Park Chippenham Wiltshire SN15 3PE Lead Inspector Sally Walker Unannounced 27 September 2005 th 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 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. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Seymour House Address Monkton Park Chippenham Wiltshire SN15 3PE 01249 653564 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Orders of St John Care Trust, Mrs Diane Bowden vacant Care Home 42 Category(ies) of MD(E) Mental Disorder (8) registration, with number OP Old Age (34) of places Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th April 2005 Brief Description of the Service: The home is situated on the outskirts of Chippenham near to the park. The building was originally built by the local authority in the 1970s and is the subject of an ongoing programme of redecoration and refurbishment. Residents accommodation is to the ground and first floors accessed by a lift and two staircases. 42 registered beds provide accommodation for older people, eight of whom may have a mental disorder. The home provides 2 of these beds for respite care. All of the residents accommodation is single bedrooms. The home also provides a 12 place day service during the week which is separately staffed. The staffing rota provides for a minimum of 4 care staff and a care leader for the mornings, 3 care staff and a care leader for the afternoon and evenings and 2 waking night staff and one member of staff sleeping in. The home has been without a registered manager since the end of August 2004. Anna Lovesey is now managing the home and her application to register is awaited. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place between 9.25am and 5.00pm. Anna Lovesey had been managing the home for 4 weeks. Many of the requirements have been inherited from previous management or are awaiting decisions from the organisation and new timescales have been agreed. Five residents and 2 staff were spoken with. The care records and fire drills records were examined. A tour of the building was made. What the service does well: What has improved since the last inspection? What they could do better: Current staffing levels do not support the manager and staff to achieve the aims and objectives of the home, allow staff to achieve the delegated administrative duties required of them, or support residents to be involved in the degree of activities and experiences that they would wish. The home needs to be sure that it is admitting people for whom it is registered with consideration of the Category of Registration at the point of referral. A review of the care needs of those residents admitted during the time that the home Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 6 was without a permanent manager may require an application to vary the category of registration. Ms Lovesey has already identified the need for care plans to direct the care and give staff information on how the care is to be provided. As this is a major project the timescale for completion has been extended. Staff need training in tissue viability in order to assess those residents who may be at risk of developing pressure sores. A tool for assessing these risks and nutritional assessments needs to be in place. 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. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 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 standard(s) 3 The home may have admitted residents with dementia during the period of time it was without a manager to register. EVIDENCE: Ms Lovesey said she was currently considering the mental health Category of Registration, she was collating information about which residents were in this category and whether there were any residents who had a diagnosis of dementia for which the home was not registered. Ms Lovesey said that she would apply to vary the Category following a review of the residents’ original diagnosis. One of the residents said that a particular staff member had made them feel welcome when they first came to the home. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 9 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 standard(s) 7, 8 & 9 Care plans do not show how residents often complex care needs are being met. Residents’ healthcare needs are being met but the care plans do not always show evidence of this. Systems are in place for the protection of residents’ safe administration of medication. EVIDENCE: The requirement that the care plans must be reviewed and revised as care needs changed with the care plans directing the care had not been achieved. Most of the information continued to be recorded in the daily report and showed little evidence of planning for or monitoring residents’ care. Residents’ healthcare needs were promptly referred when necessary to the relevant person as shown by the diary and conversations with staff who appeared to be very familiar with residents needs, but this was not always reflected by the care plans. Ms Lovesey said she had already identified the need for improvement to the care records and had set up reviews with funding agencies to start a major review. She said this was a massive undertaking and a new timescale of the end of January was agreed for completion of the work. She went on to say that there was work to be done to ensure pre-admission assessments were being fully carried out and the organisation’s new form was being used. It was also noted that some of the risk assessments would need to be included in this review. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 10 The requirement that care staff were trained in tissue viability to assist them in documenting risk assessments, monitoring pressure areas, nutrition and interventions required was in progress. One of the staff said that the district nurse had provided some training. The organisation was seeking a programme of training for its homes. The requirement that comprehensive records were kept of the incidence of pressure sores and other wounds, how they should be treated and records of progress had been actioned. The home does not now rely on district nursing notes which may not always be kept in the home. The requirement that a policy and protocol was available to staff detailing those treatments which could be delegated by the district nurse to named staff is now not applicable. The home provides no invasive treatments which, if needed, would be carried out by the district nurse. The district nurses make regular visits to the home A new system for the administration of medication had been implemented. The care leader with the delegated responsibility for the administration of medication showed the inspector the arrangements for storage and explained the system. All staff who administer the medication do so following training and assessment of competence from this senior member of staff; thereafter every three months. All medication was checked as it was received into the home, including that brought by people using the respite service. The supplying pharmacist visits regularly to check the storage arrangements and offer advice to staff. Residents can administer their own medication following a risk assessment and safe storage was available to them in their rooms for this medication. No homely remedies are given; if a resident needs any preparations they are referred to the GP for prescribing. One resident showed the inspector their inhaler which they administered themselves. They said that staff always kept a spare and this was confirmed in the medicines cabinet where the staff said that 2 supplies were kept in case of failure. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 11 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 standard(s) 12 & 13 Residents follow their own routines. Progress is being made to extend the variety of activities offered to residents. Visits from residents’ families and friends are encouraged. Residents said they enjoyed the variety and quality of the meals provided. EVIDENCE: Residents followed their own routines and spent their day where they wished. One resident said they did not feel restricted in anything they did and they could come and go as they wanted. As a matter of good practice it was noted that all of those residents who were in their bedrooms had their call alarms within easy reach. Residents said their families could visit at any time and were always made welcome. The requirement that residents’ social interests and access to the community facilities were maintained as per their wishes was in progress. Ms Lovesey said that she had recruited a part time activities person for 20 hours a week. Their Criminal Records Bureau certificate was awaited but it was expected that they would start soon. Ms Lovesey intended to implement a structured programme which would include taking residents out, group activities as well as other one to one sessions. She said that activities were being offered but they were not planned. Some residents would go for a walk in the grounds and there had been quizzes with other homes in the organisation. Ms Lovesey had bought bouquets of flowers and residents were arranging the flowers later in the day Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 12 as a group activity. Other activities included a group of singers that had come to entertain residents, a knitting group and a relative doing a slide show. One of the comment cards, received following the inspection stated that “It would be nice to have some more activities”. That day’s menu for lunch and evening meal was written on a whiteboard at the entrance to the dining room. One resident had been out to celebrate their birthday to a curry house with their family. All of those residents spoken with said that they liked to range and choice of the meals provided. Residents said they could have a cup of tea at anytime night or day. An advocate had been used by one resident who did not have close relatives. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 13 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 standard(s) 18 These standards were not considered in great detail. Proper supervision of any students on placements in the home is now in place for the protection of residents. EVIDENCE: The requirement that when schoolchildren carry out any projects in the home and were having significant contact with residents that they came under the same legislation that applied to staff or volunteers, for the protection of residents, was now not relevant. Ms Lovesey said that these students were continually supervised and only stayed in communal areas. They were not providing any personal care and Ms Lovesey had made this clear to the school before any placement was agreed. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 14 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 standard(s) 19 & 26 A programme is now in place to improve the nature of the environment. Cleanliness of the home is now generally improved although there is room for improvement. The home did not smell unpleasant. Residents benefit from a quality laundry service. EVIDENCE: Residents bedrooms were personalised with their own possessions to reflect their personality. Ms Lovesey said she had identified the residents’ bedrooms as areas of priority for redecoration and that residents were to choose the colour schemes. Ms Lovesey talked about the other issues which she had noted for repair or redecoration and was working with the new handyman to develop a prioritised programme. A bathroom would be converted into a shower room as the bath surround was cracked and not used that often. The requirement that adequate cleaning was carried out to infection control standards, including those areas which may not always be visible as in progress. The home was generally cleaned to a good standard but some dry brown marks were noted on the toilet bowls in one of the communal toilets. Ms Lovesey said that one of the cleaners was on sick leave. However it was to Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 15 be noted that there were no unpleasant odours detected at any time during the inspection. As a matter of good practice some residents said that there was no restrictions on them using their commodes during the day if they did not feel able to walk to the toilet. One resident said they had regular baths but this was when their keyworker was on duty which was not always the same time every week. A laundry person was employed for seventeen and a half hours a week and clearly took a pride in their work with a very clean area and organised system for cleaning items at the correct temperature and prompt return to residents. When this person was not on duty the care staff would carry out the laundry. It was noted that part of the laundry area had glass panels from the floor to the ceiling with no ventilation, the area was very warm on a day that was not particularly warm. The inspector advised that a ventilator should be fitted. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Current staffing levels do not allow the home to achieve all that is set out in the statement of purpose or allow staff to fully achieve the extra administrative duties required of them as well as providing quality care. Staff were concentrating on providing quality care. Staff had been through a difficult time with various different managers running the home on a temporary basis since August 2004. Staff have ensured that any difficulties they may have experienced did not have a negative effect on the residents. EVIDENCE: The staffing rota provided for 4 care staff and a care leader during the mornings, 3 care staff and a care leader during the afternoons and evenings and generally 3 waking night staff, except on 2 nights where there were 2 waking staff and 1 member of staff sleeping in. The establishment hours for care were 310 during the day, with 120 hours for care leaders and 210 hours for night care. In addition there were 85 hours for housekeeping, 64 hours for kitchen assistants and 30 hours for a chef and 37 hours for a cook. The requirement that consideration should be given to the staffing hours to ensure residents needs were met, with full provision of care and support staff and management and administrative duties excluded from the caring hours was in progress. The Commission is to meet with the organisation to discuss their staffing proposals. Ms Lovesey said that she was considering the rota to ensure that there was adequate cover over the week to meet residents needs. Vacancies were being filled and some staff were awaiting POVA clearance before commencing duties. There was a robust recruitment process in place with potential staff completing an application form, 2 references obtained, Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 17 medical clearance, POVA checks and Criminal Records Bureau certificates and a period of induction. Two residents said that the home was short staffed; one saying that staff kept leaving and that there was no one to do the washing up in the evenings and the care staff had to do it. Another residents said that staff did not have time to take them out. One staff member was seen to discuss one resident’s condition with another resident. This appeared to be an isolated incident as other staff were seen to respect residents’ privacy and confidentiality. Ms Lovesey said she would discuss these areas with staff. The cook was seen to work very sensitively with a resident who was trying to make sense of their surroundings offering a friendly chat and a cup of tea. Staff reported good access to training with recent sessions on the protection of vulnerable adults and dementia care. All the care leaders had NVQ Level 3. Ms Lovesey said that staff had not been receiving regular supervision and this was her priority and she was meeting with the care leaders to establish a plan. Care leaders confirmed that they had had infrequent supervision and they had not provided supervision for carers. Ms Lovesey said that new staff were being inducted. Ms Lovesey said that she was also instigating senior team meetings and would have a general staff meeting. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 35, 37 & 38 Residents and staff have benefited from a permanent manager to run the home. Ms Lovesey, although not yet registered for this home, has a good track record of home management when she was previously registered. Residents finances are well managed. Record keeping has suffered since the home has had no permanent manager. EVIDENCE: Ms Lovesey had been managing the home for 4 weeks and her application to register as manager is awaited. She had recently managed a large care home for the local authority and had experience of working with older people for a number of years. Ms Lovesey said she had an induction programme with the organisation and that the care services manager was available to discuss any of the organisation’s systems. She had completed training in the computerised rota system and other computer systems. A manager from one of the other homes in the organisation was also providing support. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 19 Staff said that they were pleased to have a manager that was going to stay after having a series of managers since August 2004. they said that although these managers had made improvements and supported residents and staff, their tenure was always known to be short. Staff felt that they were now entering a more settled period. They said that Ms Lovesey was very approachable. Ms Lovesey said that a quality audit was in progress with questionnaires received from residents and their relatives being collated for analysis. Residents can keep a small amount of cash in the safe for personal spending. Only the manager, the administrator and care leaders have access. A record was kept of all transactions and receipts for all purchases. The requirement that regular fire drills were carried out and recorded as per the requirements of the Fire Authority had not been actioned. Fire drills had not been recorded since the period January/March 2005. Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x 3 x x 3 x 2 x Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 21 yes 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. Standard OP 7 Regulation 15 Requirement The person registered must ensure that care plans are reviewed and revised as care needs change. The care plans must direct the care. (Ms Lovesey had already identified work to be done on the care plans. As she is new to post, the timescale has been entended). The person registered must ensure that residents social interests and access to the community facilities are maintained as per their wishes. (Ms Lovesey reported that a member of staff was now appointed to provide activites). The person registered must ensure that all staff are trained in tissue viability to assist them in documenting risk assessments, monitoring pressure areas and nutrition and interventions required. (Training was awaited from the organisation). The person registered must consider the allocation of staffing hours to ensure that residents care needs are met, with full provision of care and supoprt Timescale for action 31st January 2006 2. OP 12 16(2)(m) &(n) 30th November 2005 3. OP 8 13(1)(b) & 18(1)(c)(i ) 31st December 2005 4. OP 27 18(1)(a) 30th November 2005 Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 22 5. OP 38 23(4)(e) & 17(2) Schedule 4 para 14 13(3), 16(2)(j)& 23(2)(d) 6. OP 26 7. OP 1, 2, 4 &8 14 & CSA 2000 Section 15(1)(a) staff. Management and administrative duties must be excluded from the caring hours. (The Commission is meeting with the organisation to discuss their staffing proposals). The person registered must ensure that regular fire drills are carried out and recorded as per the requirements of the Fire Authority. (Not actioned at 27th September 2005). The person registered must ensure that adequate cleaning is carried out to infection control standards, including those areas which may not always be visible. (Actioned in part at 27.9.05 The person registered must consider the Categories for which the home is registered. If dementia care is to be provided, the home must apply to vary the category. This must be supported by appropriate staffing levels and an ongoing programme of dementia training for all staff. 27th November 2005 27th September 2005 31st December 2005 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 Good Practice Recommendations Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB 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 Seymour House D51_D01_S28133_SEYMOURHOUSE_V240366_270905_Stage4.doc Version 1.40 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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