Inspection on 17/10/06 for Stepping Stones

This inspection was carried out on 17th October 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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stepping Stones 14/07/08

Stepping Stones 04/08/07

Stepping Stones 19/02/06

Stepping Stones 06/09/05

Stepping Stones 11/01/05

Stepping Stones 20/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Stepping Stones Broadoak Newnham-on-Severn Gloucestershire GL14 1JF Lead Inspector Suzanne Collins Key Unannounced Inspection 17th October 2006 10:00 Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 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 Stepping Stones DS0000016589.V306033.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 Adults 18-65. 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. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stepping Stones Address Broadoak Newnham-on-Severn Gloucestershire GL14 1JF 01452 760304 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) Stepping Stones Resettlement Unit Limited Mr Nigel John Greenhalgh Care Home 33 Category(ies) of Learning disability (33), Sensory impairment (1) registration, with number of places Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Sensory Impairment category applies to one (1) named service user only. Category to be removed when service user leaves the home. 19th February 2006 Date of last inspection Brief Description of the Service: Stepping Stones is a registered care home for 33 adults with a learning disability who may also exhibit challenging behaviour. Accommodation is provided in 7 small units. Each unit accommodates between 3 and 7 service users. There are further developments planned in the long term to provide self-contained accommodation for up to 6 people. The home is set in extensive grounds, which includes a horticultural area, an aviary and a swimming pool. There is also a day centre on site which is staffed separately. It is attended by service users from Stepping Stones and also from other homes in the Stepping Stones group. Stepping Stones Resettlement Unit Ltd has recently retained its ISO 9002 award. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over eight and half hours. The inspector spent time in most of the houses. Time was also spent with the registered manager and assistant manager as well as several of the staff team. Service users were spoken to in most of the houses. Time was spent observing interactions between staff and service users. Survey forms were sent out. Replies were received from sixteen service users, ten members of staff, five parents/carer’s and three other professionals. Copies of the statement of purpose and service user guide were on service users files. The current fees for Stepping Stones range from £938.00 to £2,645.00 per week. What the service does well: What has improved since the last inspection? What they could do better: Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 6 There are inconsistencies with the service user files. In some cases service users have detailed care plans, communication profiles, health action plans and person centred plans. Some of the health action plans had not been filled in and there were no communication profiles. Care plans were not dated so it is unclear as to how up-to-date they were. 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. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The judgment in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Service users have a full assessment of need prior to their admission to Stepping Stones. EVIDENCE: Detailed pre-admission assessments were seen on file. On one file there was also additional information about specific dietary needs. From the preadmission assessment a detailed care plan has been produced. Staff have worked with service users to develop a person centred plan. This shows good practice. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The judgment in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The introduction of communication profiles and person centred planning is seen as a positive development within the organisation. There needs to be consistency within all the houses to ensure that this is developed for every service user. The work that has begun showed good practice. Service users are supported to take risks as part of an independent lifestyle. Copies of appropriate risk assessments were on service users files. EVIDENCE: Some of the service users have complex communication and behavioural needs. On some files there were detailed plans for supporting people with these needs. Communication profiles are in the process of being set up for service users. These profiles will be crucial when supporting people with their behavioural needs. Some service users are beginning to use the pecs system. One of pecs books was seen and had pictures and photos of the service user Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 10 and the things that were important to that person. These pecs books need to be developed to ensure that more service users can use the system. It was not clear on the care plans how people with more complex communication needs are being consulted about their care. Person centred plans are in the process of being developed. Staff stated that service users are being involved in completing the plans. Service users were spoken to about their files. One service user showed the inspector their care plan and health action plan. They also talked about what activities they do during the day. Key workers set objectives from the care plan to work on. These were not dated therefore it was unclear as to how often these are reviewed. The person centred plans need to become more integrated into the service users main file as these give vital and more holistic detail of the support needs of each person. Service users spoken to say that they make choices about what they do during the weekends and gave examples. Risk assessments are developed with the care plan. These were seen on service users files and were up to date. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 The judgment in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. All service users need to have the opportunity to take part in activities outside of the home both during the week and at weekends. The introduction of a healthy eating program is seen as a positive move. EVIDENCE: The daily records were seen for some service users. Service users are supported to access the community at weekends. These include trips to the pub, shopping, trips to the coast, and going for walks. Service users spoken to said that they visited family at weekends, and like going to the pub and trips out. Some service users work on a farm where they look after the horses and have the opportunity to drive a horse and carriage. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 12 Staff spoken to talked about trips out at the weekend. Sometimes these are restricted due to staffing issues, for example not enough drivers or the gender balance of staff. One person commented that some people are easier to take out than others. Service users need to have the opportunity to take part in activities outside of the home regardless of how much support they need. A chef is now working at Stepping Stones and is in the process of introducing a new healthy eating program. The chef runs sessions with staff showing them how to cook healthy meals from fresh ingredients rather than eating pre-prepared meals. Staff were very positive about the introduction of healthy eating and the experience of learning how to cook these meals. This shows good practice. Staff spoken to say that service users are able to make suggestions for the menu. If there is something they do not like on the menu then they are offered an alternative. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The judgment in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The person centred plans need to become part of the main file for the service users. These plans have details of the like’s dislikes aspirations etc of the service users. This vital information could be easily overlooked if not fully integrated in to the working files. EVIDENCE: Although many of the practices and interactions seen were of a good standard there needs to be a clearer audit trail of how peoples needs wishes etc. are being met in accordance with the plans. Currently there is little evidence to confirm this, as records are not kept consistently. Fencing has been erected around the site of Stepping Stones to ensure privacy for services user. Issues regarding people’s dignity have been addressed within the home. Incidents that could lead to service users becoming vulnerable have been reduced. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 14 Medication for service users is kept in each home in a secure cabinet. Medication and the records were seen and were complete. Discussions with the nurse responsible for medication confirmed the requirements from the pharmacy inspection have been completed. The nurse meets regularly with the G.P to review medication for service users. Visits by the G.P to see specific service users are recorded on their files. Health action plans are being introduced. Some of these have been filled in and some are in the process of being completed. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The judgment in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. There is a clear complaints procedure and whistle blowing policy in place. The introduction of an easy read version of the complaints procedure will ensure that all service users are able to understand it. EVIDENCE: There was information on how to make a complaint seen on all the files case tracked. There needs to be a version of this with pictures/symbols for service users who may find the present format difficult to understand. Service users spoken to knew what to do if they wanted to raise a concern or complaint. Staff new what action to take if a service user wanted to make a complaint. Staff had a good understanding of the whistle blowing policy. There have been occasions where this has been applied. Discussion with the Human Resources staff showed that these situations were investigated. The registered manager and staff spoken to were aware of the procedure for involving the adult protection team and for reporting significant incidents to the commission. Files contained detailed risk and behavioural assessments. On one file a form detailed a clear correlation between behaviour and other factors, timing, staff interaction etc. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The judgment in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. Improvements have been made to the interior of some of the houses to provide a homely atmosphere. The removal of broken furniture and rubbish from the pool and pond areas will improve the environment. EVIDENCE: Pine Brook has been redecorated since the last inspection. There are currently blinds up at the windows in the living room. The registered manager is monitoring how long they stay up. If the blinds are not successful they may look into having shutters. The bins in the bathroom in Pine Brook have been reduced to one. This is emptied regularly to prevent any unpleasant odours. There is a planned maintenance and renewal program. Two of the kitchens have been replaced since the last inspection. Maintenance work is ongoing due to the nature of the service. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 17 All rooms were seen in one house and one bungalow and the ground floor of a further four houses were seen. Bedrooms had been decorated to individual taste. All rooms were found to be clean. A few rooms have very little furniture in them due to the risks of individual service users destroying this and consequently harming themselves. In one bedroom the service user’s television had been boxed in so that it could not be damaged and cause any injuries. The service users were still able to access the controls in order to use the television and video. Two of the beds in one of the houses were unconventional due to historical risk factors. The inspector feels that when the risk assessment for these is updated that consideration is given to the possibility of introducing more standard furniture that would still ensure the safety of service users. The laundry facilities were seen in one bungalow. The laundry room is small and is also a fire exit. Baskets had been left in front of the machine and so blocked the fire exit. There is a requirement that items are moved away from the fire exit to allow a clear escape route. There is a swimming pool and large pond within the ground. A fence to protect service users from falling into the water surrounds these. The swimming pool area was generally untidy and had a couple of broken chairs beside it. The pond also had some bags of rubbish in it. The registered manager said that one service user is supported as part of his job to clean the pond of rubbish each week. This also needs to happen to the pool area. During the summer there are several gazebos put up in the grounds. These have now been taken down except for one, as a service user likes to go and sit in it. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 The judgment in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. There is inconsistency across the homes with respect to supervision. Some have this on a regular basis whilst others have it very infrequently. Across the whole service the induction process is thorough. EVIDENCE: Staff spoken to know how to access training and have attended training regularly. There is a detailed list of all training on offer each month. This is passed to the team leaders who discuss with individual staff who will attend the courses. Less that 50 of the care staff have achieved a care NVQ level Two. Team leaders are working towards their level three in care. Two staff are A1 assessors. There have been problems in the past finding assessors. The registered manager is now using a new training provider for NVQ’s. Staff said they felt supported by the team leaders and management team. Team leaders are responsible for supervision of the staff in their team. Staff supervision records were seen and in some cases it was clear that they have Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 19 regular supervision. This was not consistent for all the houses and in some cases staff did not appear to have had supervision in the past six months. Some staff that spoke to the inspector said they had supervision every six weeks, while others did not appear to have any formal supervision although they did feel supported by their team leader. Staff said that they attend a staff meeting once a month. There is a requirement that staff have regular recorded supervision meetings at least six times a year. Staff files were seen. All relevant checks had been carried out prior to someone starting work. Staff receive a copy of the staff handbook and code of conduct. They also receive a copy of the induction, which they fill out with their supervisor. New staff keep their induction book with them, so a completed one could not be seen. Staff spoken to say that they shadow staff for two weeks as part of their induction. They also said that they had been on training courses including an induction training session. Currently there are two service user vacancies. There are ten staff on shift and when they are full there are eleven staff on a shift. Staff spoken to said that they felt there was enough staff on duty. It was felt that more drivers on at weekends would enable more people to access the community. The staff files looked at contained certificates of training attended. The team leaders are currently working on their NVQ’s. Stepping Stones have changed the organisation they use to gain NVQ training and are planning for more staff to begin their NVQ awards shortly. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The judgment in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. There is a commitment to the implementation of person centred approaches from the registered manager but there needs to be a more consistent approach across all of the units to ensure it’s proper introduction. EVIDENCE: The registered manager is committed to developing the service. They have undertaken training in the development of person centred planning and has met with senior staff to ensure they also understand the principles of a person centred approaches. The registered manager is prompting healthy eating and has recently appointed a chef to work with staff to achieve this. The registered manager meets with the senior staff regularly as well as the full staff team including the night staff. The registered manager and human resources staff work closely together to ensure that staff are properly inducted and have appropriate training. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 21 There was no evidence of quality monitoring systems based on seeking the views of service users on their files. Staff spoken to confirmed service users views are clearly listened to on a day-to-day basis. There needs to be a quality assurance and quality monitoring system in place to measure success in achieving the aims, objectives, and statement of purpose of the home. Service users need to be encouraged to take a greater part in the development of the home. All maintenance requests are recorded by the team leaders and passed on to the assistant manager. There are a team of maintenance people who then carry out the work. The health and safety policy was seen. This was last reviewed in July 06. A fire safety questionnaire has been set up to check staff understanding of the fire procedures. A blank one was seen. Unfortunately the completed forms were not available to be seen. Staff spoken to did confirm that they had completed them. The fire risk assessment was carried out in May 06. Fire alarm checks are carried out every week. This was clearly recorded. The fire logbook was seen and was complete. Fire drills are also included in this book although there is not a set place to record these. Details of fire evacuations need to be recorded and kept with the logbook. During the inspection two fire doors were seen propped open. One of these also had a lock on it and is a fire exit. There is a requirement to remove the lock, as this is a fire exit. Stepping Stones DS0000016589.V306033.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 Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x 3 x 2 x x 2 x Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 23 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 YA6 Regulation 15 Requirement All service users should have a care plan that is person centred. This should include their holistic care and support needs, a communication profile, their aspirations and clear evidence of service users involvement of the care plan. Objectives set from the care plans must be dated and reviewed. An accessible version of the Complaints procedure needs to be provided which is more meaningful to people with communication difficulties. (Previous timescale 30/04/06) Timescale for action 31/03/07 2. YA22 22 31/03/07 3. YA39 24 The home develops a quality 31/03/07 assurance and quality monitoring system based on seeking service users views. Ensure all fire doors are used appropriately. Provide suitable self-closing devices where the fire doors DS0000016589.V306033.R01.S.doc 4. YA42 23 31/12/06 Stepping Stones Version 5.2 Page 24 need to remain open for ease of access. (Previous timescale 31/03/06) Ensure that all fire doors close properly. 5. YA36 18(2) Staff must have receive regular supervision meetings at least six times a year All fire exits must be kept clean of any obstructions 31/03/07 6. YA42 23(4C) 31/12/06 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 YA7 Good Practice Recommendations Consider establishing a regular forum, which promotes self-advocacy, such as a residents meeting. Stepping Stones DS0000016589.V306033.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Stepping Stones DS0000016589.V306033.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. 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!