Inspection on 21/11/06 for Sir Jules Thorn Court and Mary Court

This inspection was carried out on 21st November 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

Sir Jules Thorn Court and Mary... 14/01/09

Sir Jules Thorn Court and Mary... 10/01/08

Sir Jules Thorn Court and Mary... 09/02/06

Sir Jules Thorn Court and Mary... 15/08/05

Sir Jules Thorn Court and Mary... 20/12/04

Sir Jules Thorn Court and Mary... 10/06/04

Sir Jules Thorn Court and Mary... 15/01/04

Sir Jules Thorn Court and Mary... 21/10/03

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

CARE HOMES FOR OLDER PEOPLE Sir Jules Thorn Court and Mary Court 29-35 Prince Of Wales Drive Battersea London SW11 4SL Lead Inspector Janet Pitt Unannounced Inspection 21st November & 1st December 2006 10:00 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 Sir Jules Thorn Court and Mary Court DS0000019122.V320145.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. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sir Jules Thorn Court and Mary Court Address 29-35 Prince Of Wales Drive Battersea London SW11 4SL 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) 020 7738 0280 azadh@serviceshouses.org.uk Servite Houses Mr K A Mooniaruck Care Home 31 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (31) Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named service user is to receive personal care only by one allocated member of staff. Variation of Registration Under the High Court judgement, the service shall be named Sir Jules Thorn Court and Mary Court. The variation is for such a time until the named service user assessed needs change or they leave the home. Date of last inspection Brief Description of the Service: Sir Jules Thorn provides nursing care for up to thirty people who have mental health needs. The home provides accommodation in single rooms with ensuite facilities. Sir Jules Thorn has two floors, the home is divided into four units, known as clusters, which each have their own day room. The home has a large dining area and access to a small garden. The home is situated in Battersea, close to Battersea Park. There are accessible road and bus links to north and south London. Fees range from £444-48 to £827-12 per week. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection. Records relating to staff, residents’ care and medications were examined. Surveys were sent to fifteen residents, fifteen relatives and fifteen staff. Eleven resident, twelve relative and one member of staff surveys were returned. Information from the surveys has been included in the main body of this report. Residents were assisted by their relatives or representatives to complete their surveys. Two site visits lasting a total of six and a half hours, were made. The manager and two members of staff were spoken with at these visits. The manager completed a pre inspection questionnaire. A copy of the recent Quality Assurance survey, completed by an external agent was received. What the service does well: What has improved since the last inspection? What they could do better: Consideration must be given to providing appropriate napkins at meal times. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 6 Residents needs in relation to sexuality must be addressed and the residents must be enabled to maintain significant relationships if they wish. Minor repairs must be carried out in a timely manner, to make sure health and safety is maintained. Activities provided in the home are becoming resident focused, but tend to be in groups, rather than individual. Continuation in improvement of activities must be achieved, to make sure that residents are able to maintain skills, such as going out to shops to purchase goods. 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. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.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 Sir Jules Thorn Court and Mary Court DS0000019122.V320145.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 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team are qualified and experienced to work with the needs of the resident. Admissions to the home are not made until a needs assessment has been carried out. EVIDENCE: The majority of residents and their relatives thought that there was sufficient information available in order that a decision could be made about whether the home would suit their needs. Ten of the eleven relatives surveys received indicated that they had sufficient information on the home, when making a decision about care. One person commented that they had to find out information from the Internet ‘to find a home specifically for dementia, etc, which would keep my relative until [they] died, so that [they] would not have to move again at a very vulnerable and stressful time’. However, another comment was as follows: ‘my family were welcomed when we called on the day to inspect the home and we were given Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 9 enough information.’ All relative surveys indicated that they are welcomed when visiting the home. Of the eleven residents surveys received, five people indicated that they had not received contracts. A Primary Care Trust places all residents and there is a standard contract in place. The home must ensure that residents or their representatives receive a copy of a contract; to make sure they are aware of what is included in the fee. However, one comment from a person who had not received a contract said: ‘The staff have been so helpful and informative that I haven’t felt this necessary.’ All residents are assessed prior to and on admission. Care documentation was noted to be well organised in sections and an index available. This made looking for information easy. Pre-admission assessment information was noted to be used. On each of the six care plans examined there was a description and photograph of the resident to aid identification. Preferences for same gender carers is not consistently documented and needs further improvement. Ethnicity needs of residents are addressed in the assessments and religious needs are noted. More information is needed on how these needs are to be met. Communication needs are addressed, such as first language and whether any specific interventions are required. Sexuality is only addressed if there are concerns about behaviour. This must be developed to make sure that residents are supported to maintain significant relationships. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.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 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives are involved in planning of care. Attention is given to ensuring privacy and dignity when delivering personal care. The home recognises the need for handling end of life care and is supporting staff to dealt with this issue. Medications are handled safely and appropriately. EVIDENCE: The majority of surveys received (ten out of eleven) stated that relatives were consulted about care planning and were satisfied with care provision in Sir Jules Thorn and Mary Court. One survey respondent said they were not consulted, but raised other issues, which are being dealt with separately. Resident surveys, bar one, stated that they received care and support as needed. Comments included: ‘Staff are very supportive to [the resident] and always to us.’ and ‘I find all staff helpful and considerate to my relative.’ Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 11 All resident surveys indicated that residents are able to receive visitors in private if they wish. There has been one issue of restricting visitors, but effective communication was maintained and suitable arrangements are in place, which do not affect the resident concerned in a detrimental manner. Care plans were noted to lead from assessed needs and detailed how these needs are to be met. Routine evaluation is undertaken on all care plans and changes in needs are noted when appropriate, for example loss of appetite and interventions undertaken by staff. Appropriate risk assessments in relation to areas such as skin integrity, moving and handling and risk of absconding were in place. Residents are able to move freely around the home and the manager stated that staff are informed that Sir Jules Thorn and Mary Court is the residents’ home. One resident tries to exit out of the front door when it is open. This occurred on one of the site visits and the manager made sure that a member of staff took the resident outside for a walk. Staff treat residents with respect and were aware of their differing needs, this was evidenced by observation on site visits. Daily records have improved, but need some further work to make sure that care given is evidenced. Comments such as ‘was a bit restless’ and ate and drank well’, do not give an indication of any intervention or quantity consumed. However, good entries such as ‘had a bath and hairwash, [the resident] seemed to enjoy it, talkative and smiling’, give a clear indication of what care has been given and the resident’s reaction. Staff have attended training on bereavement and loss. Discussion with the manager indicated that this is an area, along with sexuality that needs further development, to make sure needs are met. Residents needs prevent some of them from being able to discuss end of life care, this issue is generally addressed to relatives or representatives. However, staff have highlighted reluctance on the part of some relatives to discuss this sensitive issue. The manager said that care is being taken to ascertain residents’ wishes and that other health professionals, such as the general practitioner are involved. Staff detail religious needs and respect resident choice. Medications were examined and only minor issues were found. Inspection of the Medication Administration Records (MAR) showed that allergies were not consistently noted. However, there were no gaps in administration of medications. There were specific instructions for as required medications. Discussion took place with the manager about choice of doses for variable dose Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 12 medicines. He said that this would be taken up with the general practitioner and pharmacist. Medications are kept securely and at an appropriate temperature. There was a clear audit trail of medicines into and out of the home. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Visitors are welcomed into the home and residents are able to maintain contact with their family. Improvement needs to be made in enabling residents to maintain significant relationships. Activities are provided which generally meet residents’ needs. Mealtimes are sociable and thought is given to the types of food provided. EVIDENCE: All surveys received, apart from one indicated that there are usually activities organised that residents can take part in. The one survey, which gave the answer ‘never’, included a comment that the resident is unable to participate. Comments on activities received included: [the resident] does not wish to do them’ and ‘the home organises outings in the summer and a Christmas party and are open to other events.’ Activities are organised twice daily by care workers these include listening to music, reminiscence and reading. Residents are able to chose whether to participate; this was confirmed on surveys (see above) and observations on the site visits. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 14 All relative surveys received indicated that they are able to visit the home. One surveys indicated that a resident attends local church services. Lunchtime was observed on one of the site visits. The menu file has pictures of main meals to aid choice. There is a choice of hot meals and dessert at lunchtime. For supper there is a choice of a light meal or sandwiches, plus dessert. The menu has a variety of ethnic foods, such as Caribbean, curries and traditional English food. Alternatives are available at each meal. The chef supervises lunch and sits with residents to gain their views of the food served. Condiments are available and the meal was noted to be unhurried. Consideration must be given to providing large cloth napkins, in place of blue plastic aprons, to make sure that residents are respected. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which is known by residents and their representatives. Training is given in Protection of Vulnerable Adults, there have been no referrals made, this is not due to a lack of understanding on behalf of the staff. EVIDENCE: Residents and their representatives are aware of the home’s complaint procedure. The pre inspection questionnaire completed by the manager indicated that there has been one complaint since the previous inspection, which was partly substantiated. The CSCI have received no concerns or complaints about the home. All resident and relative surveys received indicated that they are aware of how to make a complaint. There have been no investigations under Protection of Vulnerable Adults procedures since the previous inspection. Induction training includes Protection of Vulnerable Adults training. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.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, 23, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes environment is generally well; maintained, but attention needs to be paid to minor repairs being carried out in a timely manner. There are adequate numbers of communal areas, which allow residents to meet with their visitors. Cleaning is good and there are a few incidents of unpleasant odours, which are dealt with effectively. EVIDENCE: A tour of the premises was undertaken. The home was clean and tidy and free from unpleasant odours. Surveys received indicated that generally the home was clean and tidy. One survey said that at times there were unpleasant odours and that small maintenance issues, such as repairs to footrests on wheelchairs, not being dealt with in a timely manner. Other issues from this particular survey included a toilet roll holder not being fixed and a missing light Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 17 shade in a room. Attention must be paid to making sure that minor repairs are done quickly, to make sure that residents live in a safe environment. It was noted that residents are able to bring in personal items. One resident had their book cabinet and a wide variety of books. Other people had brought in their own furniture, such as chairs. The rooms are homely and comfortable. Each ‘cluster’ has a day room, with kitchen facilities, which enables staff to make hot and cold drinks and light snacks for residents. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents report that staff are able to meet their needs. Internal and external training is provided to make sure that staff have the necessary skills to care for residents. EVIDENCE: Residents are supported by an appropriate number of competent staff. Training records indicate that there is ongoing training and supervision. Training records have a date of expiry for training received and the manager uses this to make sure refresher training is given. Seven members of staff are currently undertaking NVQ level 2 and five members of staff have undertaken mental health training. Two members of staff have received bereavement and loss training. Updating manual handling procedures has been planned for all staff. There were sufficient numbers of staff on duty on the two site visits. Surveys received indicated that respondents thought there were suitable numbers of staff. One comment stated: ‘ I find all staff helpful and considerate to my relative.’ Another comment regarding a resident who is unable to express any concerns included: If [the resident] expresses a view [the resident’s] regular carer always listen and are helpful. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 19 There have been no new members of staff since the previous inspection, where the home’s recruitment procedures were seen to be satisfactory. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.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, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. He works continuously to improve services and provide an increased quality of life for residents. There is a strong ethos of being open and transparent in all areas of the running of the home. EVIDENCE: Residents’ benefit from having an experienced and proactive manager. The manager has run the home for over twenty years and has established a good working relationship with CSCI. Evidence from previous inspections shows a willingness to continually monitor and improve the service if needed. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 21 A quality assurance survey has been undertaken by an external agent, which indicated high satisfaction levels with the service provided. The pre inspection questionnaire stated that the finance officer of the company, which owns the home, manages residents’ finances and records are maintained. Health and safety records indicate that routine checks are made on electrical equipment, gas safety and fire alarm installations. Contracts are in place for these services. The home has a clinical waste contract in place. No issues relating to health and safety were observed at the time of the site visits. The manager reported that policies and procedures ere being reviewed by a working party, that includes himself, staff representatives and relatives, as a quality assurance procedure. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.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 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X 2 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 X 3 X 3 X X 3 Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 23 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 OP2 Regulation 5A Requirement The registered person must ensure that the resident or their representative has a copy of their contract detailing terms and conditions and what is included in the fee. The registered person must ensure that preference for same gender care is documented and acted upon. The registered person must ensure that residents’ sexuality needs are documented and acted upon. The registered person must ensure that daily records detail care given and interventions needed to make sure that needs are evidenced as being met. The registered person must ensure that allergies if known are documented on MAR sheets. If the resident has no allergies, then this also must be documented. The registered person must ensure that activities are developed and enable residents DS0000019122.V320145.R01.S.doc Timescale for action 30/03/07 2 OP3 12 (2) 30/03/07 3 OP3 12 (4) 30/03/07 4 OP7 17 (1) (a) & Sch 3 30/03/07 5 OP9 13 (2) 30/03/07 6 OP12 16 (2) (n) 30/03/07 Sir Jules Thorn Court and Mary Court Version 5.2 Page 24 7 OP13 12 (4) 8 OP15 12 (4) (a) 9 OP19 23 (2) (b) to participate in individual activities. The registered person must ensure that residents are able to maintain significant relationships if they wish. The registered person must ensure that an alternative to blue plastic aprons is sourced, for residents to use at mealtimes. The registered person must ensure that minor repairs are carried out in a timely manner. 30/03/07 30/03/07 30/03/07 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. Refer to Standard OP9 Good Practice Recommendations It is recommended that instructions are available for as required medications and nursing staff do not need to make a choice in the dose to be given. Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Sir Jules Thorn Court and Mary Court DS0000019122.V320145.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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