Inspection on 07/02/06 for St Anthony`s

This inspection was carried out on 7th February 2006.

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

St Anthony`s 09/05/07

St Anthony`s 09/01/07

St Anthony`s 11/05/06

St Anthony`s 23/05/05

St Anthony`s 02/11/04

St Anthony`s 10/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE St Anthony`s 3 Mildred Avenue Watford Hertfordshire WD18 7DY Lead Inspector Hazel Wynn Unannounced Inspection 7th February 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 St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 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. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Anthony`s Address 3 Mildred Avenue Watford Hertfordshire WD18 7DY 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) 01923 226 174 0208 8688375 RMD Enterprises Limited Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2005 Brief Description of the Service: St Anthonys is a care home providing personal care and accommodation for 22 older people.It is owned by RMD Enterprises Limited, which is a private company. The home is situated in a popular residential area of Watford, within 15 minutes walking distance of the town centre, with easy access to local transport inks. The home was opened in 1985 and consists of a two-storey house that has been extended and improved over recent years. All the homes bedrooms are single. None have en-suite facilities, but all have a washbasin. There is a passenger lift. The home has a beautiful and well-designed garden to the rear of the property, which is both safe and accessible to all the service users. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during the daytime of 7th February 2006 with one inspector leading the inspection process. A good part of the inspection time was spent talking to service users, a visitor and care staff. Some time was spent in the office looking at fire safety records, individual plans, risk assessments, medication and records; and a tour of the environment. Discussions were held with the proprietor, Mr Rellis (by telephone) and also with the senior in charge, at the time of inspection, and the home’s chef. Service users were welcoming and gave very good feedback about the care they receive, the meals served and the quality of life they were experiencing in the home. Generally this was a positive inspection. All but one requirement made at the last inspection (in respect of copies of the service users’ contracts being available in the home) had either been met or were nearing completion. Requirements not yet fully completed were brought forward with a comment added on the progress made to date. An immediate requirement was made for the removal of a door wedge in place for one service user’s room and the proprietor said he would ensure a safe system was fitted to allow the service user to maintain her door in an open position in a manner approved by the local fire authority. A requirement was also made for a thermometer to be purchased (by the day following this inspection) to enable a check to be made and recorded of the temperature of the medication storage area, as it was not possible to estimate whether or not the correct temperature was maintained. A recommendation was made to obtain an improved falls risk assessment tool as the tool in use was quite basic. What the service does well: The CSCI observed, during this inspection that the support provided to service users was provided with dignity and respect. A visitor stated that although his relative had only been in the home for a few weeks he now looked much healthier and happier and that there was obvious signs of greatly improved nutrition and much needed weight gain and less frailty. Several of the service users spoke highly of the care support staff and seniors; stating that they were extremely well provided for. One service user stated that she felt extremely fortunate to have been able to fill the only vacancy at the time she had needed it, as the vacancy had only existed for one day. The home was immaculately cleaned and fresh. The home provides a well-furnished and homely environment and there is a very well kept accessible garden. Staffing levels were adequate and provided for the needs of the service users to be properly met; including emotional needs as well as personal and health care needs. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 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 St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 – 5 (Standard 6 does not apply to this home) The information available to prospective service users is comprehensive and informative and together with the opportunity to visit and assess the service this enables a decision to be made regarding admission. A comprehensive pre admission assessment is undertaken and service users are involved in compling their individual plan providing them with assurance that their needs can be met. A trial period further assists the decision making process. EVIDENCE: The home maintains adequate information within both the statement of purpose and the service user guide. These were both checked at the inspection last May; these covered all areas outlined within Schedule 1 of the regulations and the service user guide and statement of purpose is made available to service users and significant others. The home has an adequate pre-admission assessment procedure and all prospective new service users have an opportunity to visit the home. The proprietor and the manager carry out a comprehensive needs assessment prior to making the final decision regarding admission for the initial trial period. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 9 Prior to admission the service users input to their initial individual plan, which provides assurance that their needs can be met. A requirement was brought forward from the last inspection for the manager/proprietor to ensure that a copy of the service user contract is on each individual file stating the terms and conditions of their stay. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 11 The service user’s health, personal and social care needs are set out in an individual plan of care and their needs are fully met. A policy and procedure is in place for service users who are able to be responsible for their own medication. Medication policies and procedures are in place for dealing with medicines in a manner that provides protection for service users; although a check must be kept to ensure medication is always stored at the correct temperature. Service treated feel they are treated with dignity and respect and that their privacy is guarded. Service users and their families users can feel assured that they will be provided with a sensitive and respectful service should the service user choose to remain in the home at the time of their death. EVIDENCE: A sample of care plans was perused during this inspection and these contained the individual service user’s health, personal and social care needs with guidance to staff regarding the service users preference in meeting needs. The progress notes as well as service user and a relative’s feedback provided evidence that health care needs were fully met. Individual plans are kept reviewed. The falls risk assessment tool should be reviewed as there are more comprehensive tools available. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 11 Protocols are in place for service users who would be able to responsible for their own medication. The CSCI noted that the storage temperature for medication was not kept reviewed and could not be assessed; a requirement was made for the medication storage area to be maintained at the required temperature and that this be checked and recorded daily. Medication was otherwise well managed and their were no gaps in the Medication Administration Records. During this inspection, the inspector observed and heard from service users that that personal care and assistance is of a very high standard, and met the individual needs and preferences of individual service users. Care staff were observed to approach their duties to service users in an unobtrusive and sensitive manner. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Service users are very satisfied with the lifestyle experienced in the home and it appears that preferences for social, cultural, social, religious and recreational interests and needs are met. Contact with family and friends/significant others is welcomed and supported and service users are afforded choice and control over their own lives. Service users are supported to maintain community contacts and to enjoy community activity wherever possible. The food served in the home is of good quality, nourishing and plentiful and is served in comfortable settings. EVIDENCE: Service users provided very good feedback during this inspection with regard to the quality of life experienced in the home and to the services provided. A co-ordinator has been employed for part of three days per week in response to identified needs of service users and various activities are now being enjoyed. Service users have also enjoyed trips out and enjoyed some garden activities in fairer weather. Several service users stated that life couldn’t be better and the home meets all their needs and more; they spoke very highly of the home’s care team and management. Where possible the home tries to accommodate everyone’s individual preferences and feedback and suggestions are sought in all aspects. This promotes autonomy and choice. Visitors are St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 13 welcome and the home promotes integration with the local community in accordance with service users preferences. The home’s chef explained that she meets with the service users for feedback in respect of the meals served. The four-week menu, seen during this inspection, included good variety, the provision of good nutrition and choice. All of the service users spoken with said the food was excellent and plentiful. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 -18 Service users can be confident that complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected and service users are protected from abuse. EVIDENCE: The home has a complaints policy and procedure and service users stated that “if anything was troubling them the staff would soon put it right”. The senior in charge explained that referrals are made to Age Concern if service users need support regarding their legal rights and some service users have a family solicitor to support any needs. Service users are able to vote using the postal service if they are unable to go in person to the polling station. All staff have received training in abuse awareness and most staff have now attended the Hertfordshire Abuse Training sessions with just a few more awaiting dates to be allocated to them. The senior explained that she has passed on information gained during her own abuse awareness training during staff meetings and supervision sessions. The Hertfordshire Adult Protection Procedures Poster is clearly displayed in the office and the manual produced by the Adult Protection Team is accessible to all staff on the office shelf. The induction check list includes introduction to abuse awareness and whistle blowing and the dual signed induction checklists were seen at this inspection. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 26 Action has been taken to refurbish areas of the home requiring this; some outstanding work remains but an action plan is in place but the requirement should remain until completion as safety will remain compromised until flooring is levelled and some floor coverings replaced. Service users requiring specialist equipment do now have this in place (as far as the individual plans sampled indicated as an assessed need). Service users rooms are very comfortable and personalised. Privacy is provided in the, one, shared room. The home is clean, pleasant and hygienic. EVIDENCE: During the last inspection several maintenance issues were highlighted and requirements were made. Action had been taken to meet requirements made at the last inspection, and much of the work has been carried out; some work remains on the action plan. Estimates were awaited to level an area of uneven flooring and re-carpet/re-cover the floors to hall, stairs and landings and some bedrooms; estimates were expected during the week of the inspection; service users safety will remain in jeopardy until the work has been satisfactorily completed and therefore, the requirement is brought forward but with St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 16 acknowledgement of the progress made to date. Some of the bedrooms had been re-carpeted and some of the communal areas had been recovered. A new extractor had been installed in the kitchen and all of the bathrooms, toilets and the sluice room had been redecorated. All of the bedrooms visited were pleasantly decorated and personalised. Damage to a ceiling (room 18) had been repaired, however, a stain has re-appeared and the proprietor explained that the cause is currently being investigated so that this can be remedied. All staff have attended an interim fire safety training session whilst awaiting a certificated course scheduled to take place on 1st of March by an accredited provider. The fire records were up to date and show that regular checks and testing takes place. Fire drills are held regularly and the last one recorded was October 2005 with the next one being planned. A service contract is maintained for the testing of the fire safety system. The home is comfortably and pleasantly furnished and has a very homely atmosphere; it was noted to be immaculately clean and fresh throughout. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Service users needs are met by the numbers of staff on duty and by the skill mix. Staff are equipped with the training they require to provide a safe service to the service users. Robust recruitment practises are employed by the proprietor/manager with policies and procedures in place. The evidence of training for staff provides assurance that staff are trained and competent to their jobs. EVIDENCE: Service users stated that staff are always readily available to them and it was observed, during this inspection that the home was adequately staffed. Staff did not appear to be hurried and were observed to approach service users with patience and respectful pause. The training planner and evidence of training seen at this inspection was quite satisfactory. All mandatory training had been updated on a rolling planner and additional training had also been undertaken or was planned. The senior has an overseas nurse qualification and is enrolling on NVQ Level 4. One staff member has achieved level III NVQ and one holds Level II NVQ; it is hoped that encouragement will continue for at least 50 of the workforce to achieve at least level II NVQ in the foreseeable future. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 The home is well managed by a fit person and a high standard of care is provided to service users. Further work needs completion to improve the safety standards in relation to the environment. The home is run according to the service users preference and improvements in safety of the environment, when completed will support the home’s endeavours for it to be run in the best interests of the service users. Service users financial interests are safeguarded by robust accounting procedures. Staff are appropriately and formally supervised on a regular scheduled basis. Records sampled were well maintained but a record needs to be kept of the temperature of the medication storage area. The falls risk assessment tool should be reviewed. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 19 Action has been taken to improve health, safety and welfare of service users and staff but completion of previous requirements remain outstanding. As stated above, the main concerns relate to outstanding work required to improve the safety of the environment. Estimates for completion of the outstanding works required were expected to arrive during the latter part of the week of this inspection. Once the outstanding work is completed to a satisfactory standard, the health, safety and welfare of service users and staff should be at a satisfactory level. A lot of investment had been made in working towards meeting the requirements. EVIDENCE: Robust checks are carried out on proprietor/managers by the CSCI prior to registration and were carried out in the same manner under previous bodies. The proprietor/manager has taken action toward meeting requirements and has completed the majority of the requirements made at the last inspection and has an action plan in place to complete outstanding requirements within a short time frame. Service users spoke highly of the service and those providing their care during this inspection and feel the service is run in their best interest and according to individual preference. Staff were observed by the CSCI, during this inspection, to be meeting care needs in accordance with the care plan and in an individualised manner. Service users (or relatives on their behalf) handle their own money wherever possible however the home has a pocket money holding system. This is where service users choose to keep small amounts of money in the safe which pays for hairdressing, newspapers etc. Residents are offered a key to their room upon arrival; The standard regarding service users personal finance was looked at more in depth during the last inspection and no concerns raised. Age concern are contacted by the home if the staff assess that a service user requires support or advice. The records sampled at this inspection were satisfactorily maintained and fire safety records had been brought up to standard and action taken to provide all staff with certificated fire safety training; an interim in house fire safety course had already been provided and a certificated course had been arranged to take place on 1st March 2006. Staff confirmed that they receive regular formal supervision at a minimum of six sessions per year and the senior has built in a schedule to ensure that this is appropriately managed. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 1 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 3 18 3 1 1 3 3 3 3 1 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 3 3 1 St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 21 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 OP2 Regulation 5 (1) (c) Requirement Timescale for action 28/02/06 4. OP24 16 (2) (c) 5. OP19 23 (2) (a) 6. OP19 23 (2) (b) The proprietor must ensure a copy of the current contract that has been signed by the service user or their representative is maintained within the home at all times. Brought forward from the previous inspection. The proprietor must replace all 30/03/06 bedroom carpets that are worn. (It is acknowledged that some have been replaced since the last inspection and that a quote is awaited for the remaining work to be completed). The proprietor must investigate 30/03/06 and remedy the cause of the stain to the ceiling in room 18 and make new. (It is acknowledged that repair work was recently carried out in response to a requirement made at the last inspection, and that the stain is recent). The proprietor must repair and 30/03/06 level out the flooring outside rooms 13,14,18 and replace the corridor carpet. This requirement remains outstanding from the DS0000019534.V282409.R01.S.doc Version 5.1 St Anthony`s Page 22 7. OP19 16 (2) (c) 8 OP9 13 8 OP19OP38 13 (4) (c) last inspection (It is acknowledged that a list of work required has been completed and that estimates were awaited at the time of inspection for the remaining work to be completed). The proprietor must replace the 30/03/06 corridor carpet on the first floor. (This requirement is brought forward from the last inspection and it is acknowledged that an estimate is awaited from the suppliers). Ensure medication is stored at 08/02/06 the correct temperature and that the temperature is checked and recorded daily. If the temperature is found to exceed the pharmaceutical manufactures instructions for storage this must be remedied. Door wedge to a service users 07/02/06 room must be removed immediately and were assessed needs dictate that the service users door needs to be maintained in an open position then an appropriate method as recognised by the local fire authority should be installed. This was discussed during the inspection and a feedback form was left with the immediate requirement noted on this. (The proprietor stated, during feedback at the time of inspection, that he would instruct his fire safety-servicing provider to fit an approved, fire alarm sensitive, automatic door closure). St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 23 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 OP7 Good Practice Recommendations Review the falls risk assessment tool and take advice with a view to replacing this with a more comprehensive model. Advice given to approach the community/district nurse or appropriate website. St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 St Anthony`s DS0000019534.V282409.R01.S.doc Version 5.1 Page 25 - 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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