CARE HOMES FOR OLDER PEOPLE
St Marys Haven St Marys Street Penzance Cornwall TR18 2DJ Lead Inspector
Paul Freeman Announced 25 July 2005 10.00 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. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service St Marys Haven Address St Marys Street Penzance Cornwall TR18 2DJ 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) 01736 368585 01736 331982 The Presentation Sisters Sister Francis Xavier Houlihan Care Home 27 Category(ies) of Dementia - over 65 years of age (3), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (27) St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to Service users to include up to Service users to include up to (MD(E)) Total number of service users 27 adults of old age (OP) 3 adults aged over 65 with dementia (DE(E)) 3 adults aged over 65 with a mental illness not to exceed a maximum of 27 Date of last inspection 11 March 2005 Brief Description of the Service: St Mary’s Haven is a residential care home registered to accommodate twentyseven residents over sixty-five years of age. The home is also registered to accomodate three older peole who experince dementia. Sanctuary Housing Association along with the home is run by the Presentation Sisters of Penzance and the building is owned by Santuary Housing Association. Within the grounds is another registered home for nine residents, a day centre for up to fifty older people as well as a group of terraced flats. St Mary’s Haven is an interdenominational home working in a Christian atmosphere. Opportunities are provided for regular Christian services, Catholic, Anglican and Methodist Ministers may also attend to the spiritual needs of the service users.St Mary’s Haven is located near the town centre of Penzance and has access to local amenities with good transport links. The home is furnished and maintained to a good stadard and is accessible for people who experience disabilites. A passenger lift is also provided at the home to allow easy access thgroughout. Communial space is situated on the ground and first floors. There are twenty one single rooms and three shared rooms and a high percentage of the bedrooms have ensuite facilites and been presonalised by the occupants. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned announced inspection took place on 25 July 2005 and 27 July 2005. The purpose of the inspection was to consider some of the key standards that include assessment and care planning, health and safety and staffing arrangements. The registered manager, residents and staff were consulted about the services and facilities provided. The environment, records and documents were also considered. The requirements and recommendations set at the last inspection had been worked upon and the registered manager, staff and residents fully cooperated and were very helpful throughout the inspection period. Relatives and friends of the residents were also consulted. What the service does well:
Flexible arrangements are in place for prospective residents and their relatives or representatives to visit the home to help them decide if it a suitable setting. The staff at the home takes careful account of the residents health and medical services are accessed promptly. The records show that health practitioners regularly visit the home and are called upon efficiently and promptly when required. Residents said they were very satisfied with the way in which their health needs are met and were confidant that medical assistance was provided when required. The standard of care is good and the home has a relaxed atmosphere. Positive relationships exist between the residents and staff and resident said they are treated in a respectful and dignified manner. The visiting arrangements are flexible and residents are able to decide where they meet with their visitors, this makes sure their privacy is not compromised. Residents and visitors commented the staff and managers at the home positively welcome visitors. A nutritionally balanced menu is provided each day and residents are able to choose the food they eat. Residents said their preferences are accommodated and were very satisfied with the food provided. Kitchen staff regularly consult with residents about the menu and the kitchen is well organised and good standards of hygiene and safety are maintained. Satisfactory arrangements are in place to deal with any concerns or complaints residents may have and to protect residents from abuse. Residents commented there are no barriers to raising any issues or concerns and they are confidant these will be dealt with in an efficient and satisfactory manner. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 6 A satisfactory policies and procedures are in place to protect residents from abuse and the documents guide and direct the action that is taken if any concerns arise. Sufficient number of staff is on duty each day and night to meet the needs of residents and provide a safe place to live. Two waking staff is on duty overnight and are able to call upon a senior staff member if emergencies occur. Residents commented they were very satisfied with the manner in which the staff undertake their duties and found staff to be responsive, reliable and efficient. Residents said they were able to direct their own care and the staff are readily available when they are required. The home is well run and managed and the management team actively support and advise staff on a day to day basis. The registered manager is experienced in social care and is committed to providing quality services and facilities. Residents and visitors are very positive and confident about the manner in which the home is run and commented they are regularly consulted about the services and facilities provided. What has improved since the last inspection? What they could do better:
Prospective residents are assessed to make sure the service is able to meet their needs. The assessments also take account of the views of any specialist workers that are involved with the individual. The records of the assessments summarise the needs, care and support of the individual concerned and are satisfactory for individuals who are able to direct their own care. Where prospective residents are unable to direct their own care more detailed information needs to be included in the assessment record. This will make sure that residents’ needs are met in a manner that reflects their choices and the staff are provided with clear guidance about the care and support the person requires.
St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 7 There have been some changes in the staff group recently after a period of stability but robust arrangements to recruit new staff are in place. The records about the staffs’ recruitment do not reflect the care taken and do not meet with the regulatory requirements. There are a number of policies and procedures in place to promote safe working practices and a safe environment for the residents and staff. The arrangements to manage risks that individual residents may experience need to be improved. This can be achieved by the completion of a risk assessment and action plan where required when any situation arises that could potentially compromise that health, safety or welfare of any resident or staff member. 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 Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 8 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 St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 9 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 and 5. The admissions process is well managed and prospective residents are able to visit the home to help them decide if it is a suitable setting. Each prospective resident is assessed by experiences staff at the home to make sure their needs can be met. The records of the assessment need to be more detailed in order that appropriate care and support are provided. EVIDENCE: Residents that had moved to the care home following the last inspection visit on 11 March 2005 said they were positively welcomed when they arrived at the home. The residents commented that staff from the home had talked with them about their needs and the most appropriate ways of providing care and support. The residents said that staff had helped them settle and made sure they knew their way around. The records showed that staff at the home had completed an assessment and this also takes account of any assessments that have been done by speaclist involved with the prospective resident. The information provided in the assessments gives an overview of the needs, care and support required by each person. The detail provided was satisfactory for residents that are able to
St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 10 direct their own care but more information is necessary where a prospective resident relies upon the care staff to meet their needs. This will make sure that the care and support provided occurs in a manner that reflects the person’s choice and preference and takes account of their needs and safety. Prospective residents, their families and representatives are able to visit the home to help them decide if it is a suitable place to live. The visiting arrangements are flexible and are based upon the prospective residents views about the most appropriate arrangements to help them make a decision about the move. This also helps to make sure the providers can determine if they are able to meet the needs of the prospective resident based upon an evidence based judgement. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 11 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 and 10 Each resident has a care plan that outlines the care and support required. Some of the care plans needs to be more detailed and provide satisfactory advice, guidance and direction for the staff. This will make sure care is provided in a manner that reflects the individual’s preferences and choices. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. Residents are treated with respect and dignity and their rights are upheld. EVIDENCE: Each resident has a care plan that outlines the care and support required and provides staff with information about the persons needs. A summary of the care plan is located in each resident’s bedroom and some of the residents said their record accurately outlined the services and support they require. The care plans are satisfactory for residents who are able to direct their own care and play an active role in meeting their own day to day needs. Where residents are not able to direct their own care more information and detail is required in the care plan. This will make sure the staff are provided with appropriate guidance and direction about the care and support as well as taking account of the choices and preference of the person concerned.
St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 12 The care plans are regularly reviewed with the residents and staff to make sure they are up to date and the persons needs have not changed. A satisfactory record is made of the review in the residents’ records. Where appropriate the individuals care plan is also amended. Residents said the staff were diligent in monitoring their health needs and medical services were promptly accessed when required. The records show that general practitioners and other health staff regularly visit residents where necessary. Residents commented they were very confidant about the manner in which they are supported about their health. A District Nurse confirmed to the Inspector that high standards of care were provided, there was good communication with the staff and management and the staff were cooperative and positively responded to any guidance or direction the District Nurse offered. Relatives and the representatives of residents commented they were very satisfied with the care and support provided and found the staff positively communicated at all times. Residents said they were very satisfied with the dignified and respectful manner in which staff undertake their duties. The residents commented they had built positive relationships with staff and had considerable confidence in the care and support given. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 Good flexible visiting arrangements are in place and visitors are positively welcomed. Residents decided where they meet their visitors and there privacy is respected. Dietary needs of residents are well catered for with a balanced and varied selection of food available each day that meets residents’ tastes and choices. EVIDENCE: The statement of purpose, service users guide and other documentation state that visitors are welcomed at the care home and flexible visiting arrangements are in place. Residents said they were able to decide where to meet with visitors and are very satisfied about the welcome provided by the staff. Visitors commented on the positive reception they received when visiting and the good standard of communication that occurs whenever they have contact with the management and staff. Residents said they were very satisfied with the food and menu provided. On a daily basis kitchen staff individually ask residents to choose their menu for that day and residents commented their preferences are always taken into account. Refreshments are regularly provided throughout the day and are available to residents when required. A nutritionally balanced menu is in operation and this based upon the principles of healthy eating. The staff also caters for special diets where this is required. Residents commented the kitchen was well organised and staff were helpful and responsive to any requests they made.
St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 14 The kitchen area is clean and hygienic and the records shown the area is regularly cleaned to a good standard. The equipment in the kitchen is well maintained and replaced when required. The kitchen staff evidently has good rapport and teamwork and said they felt well supported. Satisfactory arrangements are in place to promote safe working practises which are supported by appropriate policies and procedures. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Positive arrangements are in place to protect residents and respond to any complaints or concerns. EVIDENCE: A satisfactory policy and procedure for dealing with complaints is in place and the Registered Manager or the CSCI have received no complaints following the last inspection on 11 March 2005. Each resident is provided with a copy of the complaint policy and procedure and the arrangements are satisfactorily stated in the statement of purpose and service users guide. Residents said there are no barriers to raising any issues, concerns or complaints and they are confidant that any issues will be dealt with efficiently, competently and in a satisfactory manner. Satisfactory arrangements are also in place to protect residents from abuse and a suitable policy and procedure is in place to guide and direct the staff if any concerns arise. Suitable whistle blowing arrangements are in place for staff and this makes sure that staff can report any concerns to a third party if they feel unable to raise the matter with the providers. This provides further protection for the residents. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21 and 25. The standard of the environment and the facilities is good providing residents with an attractive and homely place to live. EVIDENCE: The home is maintained to a high standard and the furniture, furnishings and fitting are domestic in nature. The layout of the home is satisfactory, generally accessible and comfortable. The home is regularly maintained and a programme of redecoration is in place. Residents said that any faults that occur are dealt with promptly and were very complementary about the standard of work and efficiency of the maintenance staff member employed by the home. Residents said they were very satisfied with the facilities provided and all were very pleased about their individual bedrooms that are also maintained to a good standard and many have been personalised by the occupant. The furniture provided in each room is satisfactory and residents are able to bring some of thier own furniture if they wish.
St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 17 Bathrooms and toilets are distributed throughout the home and some of the bedrooms are provided with ensuite facilities. One of the bathrooms has recently been refurbished and speaclist equipment has been provided to assist resident’s who experience disabilities. Plans have been established to upgrade a further bathroom and this will also have speaclist equipment for people who have disabilities. When completed the two bathrooms will further improve the facilities and services provided. The heating and lighting are satisfactory and the water temperature is suitably adjusted to comply with the appropriate regulations. Visitors said they were very pleased with the facilities and high standard of the environment. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 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 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 and 29 There is an enthusiastic workforce and sufficient numbers of staff who work positively with residents to provide a good quality of life and meet their individual needs. The recruitment arrangements are robust but the records require improvement. This makes sure that staff recruited have the appropriate skills to provide a good standard of care and protect residents from abuse. EVIDENCE: The records show that sufficient staff is on duty each day and night to meet the needs of residents and to maintain a safe and hygienic environment. Additional staff is employed when this is required. Two waking night staff are on duty overnight and reliable on call arrangements are in place if assistance is required. Residents commented that staff promptly respond to any requests and there is not an unreasonable delay when staff are called. Residents said they were very satisfied with the care and support they receive and found the staff to be reliable, flexible and responsive to any requests they made. There have been recent changes to the staff personnel after a period of stability but sufficient numbers of staff are employed and new staff have been appropriately introduced. The staff members therefore have a wide range of skills and abilities to meet the needs of residents. The records of recently appointed staff showed that steps have been taken to satisfactorily recruit, select and vet the candidates concerned. The consideration given to recruitment of each staff member is not reflected in the
St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 19 records that are made. Some of the records that are required by regulation were also incomplete. The residents said that new staff had the suitable skills and abilities to meet their needs and there have been no reduction or change in the good standard of care and support they receive. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 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 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) 31, 35 and 38. The home is well run and managed in a manner that actively advises, supports and directs the staff. Satisfactory arrangements are in place to provide a safe environment for residents and staff but the arrangements to manage any risks that residents experience need to improve. This will make sure that all reasonable steps are taken to promote the health, welfare and well being of residents and staff. EVIDENCE: The registered manager at the home is very experienced in the social care and is suitably qualified. The registered manger actively supports, advises and guides staff and regularly consults with residents about the services and facilities provided. Three senior staff have recently been appointed to assist the registered manger in the day to day running of the care home. Each of the managers takes a lead role in certain aspects of service delivery e.g. assessment of
St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 21 prospective residents, care and support and training. The appointments have also ensured that a senior staff member is on duty for all waking hours. Residents and visitors commented they found the home to be well run and were regularly consulted about the service and facilities provided. The managers of the home will assist residents to manage their spending monies when no third party is available. Detailed records are made of each transaction, which is signed by the resident, or two staff members when required. There are no barriers to the residents accessing their records at any time. The records show that policies and procedures have been established to promote safe working practices and provide a healthy and hygienic environment. The services and equipment at the home are regularly maintained and serviced and suitable arrangements are in place about fire precautions and the action to take in the event of a fire. The arrangement to manage risks need to be improved. The management of risks around the environment and related to any equipment at the home are satisfactory. Where a resident’s health welfare or safety is potentially compromised a risk assessment is not always completed to determine if any additional action is required to protect the individual concerned and to ensure that no measures are necessary to also promote the health and welfare of the staff. St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 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 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 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 3 x x x 3 x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x 3 x x 2 St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 23 no 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 3 Regulation 14 Requirement Timescale for action 30.11.05 2. 7 15 3. 29 19 and sch 2 13 4. 38 The staff at the care home must undertake a detailed assessment of the needs of prospective service users. Service users care plans must 30.12.05 provided detailed information, guidance and direction for staff about the most appropriate ways of meeting assessed needs. The records required by 30.10.05 regulation about the recruitment and selection of staff must be in place. A risk assessment must be 30.10.05 completed when any situation arises that could compromise the health, safety or welfare of servivce users or staff. 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 None. Good Practice Recommendations St Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Marys Haven D52-D04 S8905 St Marys Haven V228865 250705 Stage 4.doc Version 1.40 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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
