Inspection on 12/04/05 for The Branches

This inspection was carried out on 12th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Branches 15/08/07

The Branches 13/07/06

The Branches 27/10/05

The Branches 24/09/04

The Branches 29/04/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE The Branches Springwell Road Jarrow Tyne and Wear NE32 5TQ Lead Inspector Sam Doku Unannounced 12 April 2005 6.40:00am 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. The Branches Version 1.10 Page 3 SERVICE INFORMATION Name of service The Branches Address Springwell Road Jarrow Tyne and Wear NE32 5TQ 0191 489 1208 0191 489 1208 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) Mr Abdul Majeed Khan Mrs Eileen Cromar PC Care home only 24 Category(ies) of Dementia – 2 registration, with number Dementia - over 65 – 4 of places Old age – 24 The Branches Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24 September 2004 Brief Description of the Service: The home is registered for 24 places and currently provides service for 2 people under 65 with dementia and 4 people over 65 with dementia. At the time of the inspection there was one vacancy in the home. The home is not registered to provide nursing or intermedaite care. The Branches is a large established property that has been converted into a care home, offering personal care for up to 24 older people. The home is located in a central position close to local amenities, with the added benefit of a large garden area that offers seclusion and privacy. All bedrooms are single rooms situated on two floors, and there are toilets and bathrooms situated throughout the building. There are no en-suite tiolet facilities in the home. The living areas are spacious and present a homely atmosphere, and there are ample car parking spaces to facilitate easy access. The home is clean and environmentally comfortable. There is a large well maintained garden to the front of home overlooking the Springwell Park. Another garden is being created to the back of home to provide extra choice for residents. The Branches Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In discussions with the service users and the staff, it was evident that the service users prefer to be called residents. Consequently, the term residents is used throughout this report. The unannounced inspection was carried out at 6:40 in the morning to observe the care offered to the service users by the night staff before handing over to the day staff at 8:00 in the morning. On arrival there were two care staff on duty, one on the ground floor and the other on the first floor. There was no resident in the lounge at the time of arrival but the first two service users came down in the lounge just after 7:00 a.m. Both residents confirmed that they are early risers and like to be up by 7:00 a.m. Both residents were offered cups of tea by the cook. The atmosphere in the home was calm and orderly. There was no odour in the home and all areas of the home were clean and well ordered. The inspection process involved talking to residents, sitting in the lounge and observing staff interaction with the residents, discussions with the manager and care staff, tour of the house, inspection of the drugs administration system, examination of health and safety records and residents personal file including care plans. What the service does well: During the time of the inspection a number of good care practices were observed. Residents were offered a cup of tea as soon as they came down to the lounge. Residents were allowed to have a lie-in and to get up when they wanted. Staff were courteous and respectful of the wishes of the residents. The home has relevant information for prospective residents in the form of service user guide. Proper assessments have been carried for all the residents and care plans put together to enable staff to follow the agreed care plans for each resident. This ensured that the personal and healthcare needs of the residents are met consistently, and evidence of these had been fully documented in the residents’ files. Practices observed showed that residents have choices offered them, including when to retire or rise, choice of meals and opportunity to be involved in The Branches Version 1.10 Page 6 organised social and recreational activities. Resident spoken with stated that the staff respect their privacy and treat them with dignity. The home has good complaints procedure in place and staff have had training in recognising and dealing with any form of abuse in the home. Details of how to make complaint was displayed for all residents and visitors to see. The home was clean and maintained to good standard. All the bedrooms that were inspected were clean and appropriately furnished. The home encourages residents to bring personal belongings into the home and evidence of this was noted in those rooms that were inspected. The home has very good system for recruiting staff including clearance from the Criminal Records Bureau before new employees commence work. The staff turnover in the home is very low and the residents expressed satisfaction with having long-standing staff to look after them. What has improved since the last inspection? What they could do better: The arrangements in the home for ensuring safety and security of medicines in were not considered satisfactory. The keys to the medicines cupboards and trolleys were left lying in the treatment room with the door left open. On the morning of the inspection, staff were observed on two occasions to transport residents in wheelchairs without using the foot rest. This practice is considered a safety hazard and the manager was asked to ensure that the practice ceases. The two most recently admitted residents, 31 March 2005 and 1 April 2005 respectively have still not been issued with contract with the home. The manager was advised to take appropriate steps to ensure that new residents are issued with contracts as soon as practicable. The Branches Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Branches Version 1.10 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 The Branches Version 1.10 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) 2, 3, 4 and 5. The policy of supplying residents at the point of admission to the home with contracts had not always been observed. Sufficient pre-admission information is available to prospective residents and their relatives to enable them to make informed choice about whether or not to come and live at The Branches. EVIDENCE: During the inspection, four residents files were examined, including the two most recently admitted residents. The two most recently residents did not have terms and conditions of residence. One gentleman was spoken with confirmed that he was not aware of any such document contact with the home. However, the manger explained that both admissions were from a hospital setting and were more or less emergency admissions, hence the reason for the delay in issuing the terms and condition of residence to them. During the inspection the home’s service user guide and other written policies relating to admission process were examined. These were found to contain good information to residents about the admission process, pre-admission The Branches Version 1.10 Page 10 procedures and the policy of inviting prospective residents to visit the home and to meet with other residents and staff before the final date for admission is arranged. Examination of four residents’ files showed evidence of pre-admission assessment documentation by the both care manager and the home. Three residents were spoken with and they all confirmed that they and their families had the opportunity to visit the home before deciding on coming to live in the home. Care staff who were interviewed also confirmed the policy of inviting residents to visit the home, and cited several examples of such visits in recent months. The Branches Version 1.10 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, 9, 10. The home has suitable arrangements in place for meeting the health, personal and social care needs of the residents. EVIDENCE: A number of residents’ files were examined and these provided evidence of health care needs being met. The records contained evidence of visits by GPs, District Nurses, Chiropodists, Opticians, and also visits by or to other specialist healthcare personnel such as hospital consultants. The records also contained evidence of regular checks on residents’ weights and nutritional assessments being carried out to ensure that all the residents receive adequate and nutritious diet. The residents who were spoken with confirmed that they regularly receive medical attention from their GPs. One resident stated that “the staff would always get a doctor or a nurse for you if you don’t feel well”. Another resident spoke about her recent outpatient appointment with a specialist at a local hospital. The care plans provided details of care needs assessment and how those needs were to be met. The progress report sheets provided evidence of the care provided on a daily basis. Staff who were spoken with had good knowledge of the of the care plans relating to the specific residents. The Branches Version 1.10 Page 12 Residents who were spoken with said they feel their care needs are always met in the home. The home continues to maintain written policies for the handling of medication. A random check of medicines was carried out and no discrepancies were noted. The records of receipts, administration and disposal were all properly maintained and all medicines were accounted for. However, on arrival in the home, the inspector noted that the treatment room was left open and the keys to the medicines trolley and cupboards were left lying. It is recommended that a key holding policy should be put in place ensure safety of medicines held in the home. Practices observed during the inspection would indicate that residents’ dignity and privacy are respected. Staff were observed to knock on residents doors before making entry. Two residents were asked discreetly by the staff if they wanted assistance with personal care need. During breakfast three residents commented on how the carers treat them with respect and dignity. One resident said “ they are like a family to us”. The Branches Version 1.10 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) 12, 13, 14, 15. The staff and the management ensure that daily routines and recreational activities take account of individual preferences. Meals are managed so as to provide choice and pleasant surrounding which ensures a positive experience for the residents. EVIDENCE: A number of residents’ files were examined and these contained evidence of residents’ social interests being recorded. The residents who were spoken with indicated that they have often discussed with staff the kind of activities they would like to engage in. There was comprehensive record of activities that residents have taken part in. Residents indicated that they enjoy the activities organised for them. They also confirmed that they are free to join in social activities if they wish and that they are not made to join in activities if they did not want to. Two residents commented on the opportunities available for them to visit relatives and friends if they wanted. One other resident described how she is supported to visit her local hairdresser once week. At the time of the inspection the inspector noticed the flexible approach adopted by the staff regarding arrangements for getting residents up in the The Branches Version 1.10 Page 14 morning. It was noted that residents who wanted to have a lie-in were allowed to do so. The staff on night duty confirmed that it is the policy of the home that residents choose when to go to bed and when to get up. This was evidenced by the fact that at 7.00 in the morning there were only two residents up and in the lounge. The two residents indicated that it is their choice to get up that time of the morning. Breakfast was organised in a way that fitted in with the flexible routines in the home. The manager commented that this allows residents the opportunity to have their break as and when they get out of bed. Cooked and continental breakfast is available each day thus providing choice for the residents. Three residents said they found the arrangements for meals excellent because they are able to have their meals when they want and where they want it. The cook also confirmed her belief in this flexible approach as she believes it allows residents choice of when to have their meals. The Branches Version 1.10 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, 17, 18. The home has a clear and easy to understand complaints policy, which is accessible to the residents and relatives. Suitable arrangements are in place to ensure that residents are protected from all forms of abuse and to protect their rights. EVIDENCE: The manager has arranged for the home’s complaints procedure to be displayed in the home, thus making it accessible to both residents and visitors. The procedure is also included in the service user guide and statement of purpose. Residents who were spoken with stated that they are aware of the complaints procedure and one resident said she has a copy of the service user guide, which includes a copy of the complaints procedure. A recent complaint by a visitor to the home led to the instigation of Protection of Vulnerable Adult (POVA) strategy meeting. The home followed its complaints procedure and co-operated in the investigation and fully implemented the recommendations of the investigating team. Suitable training on POVA has been provided for the majority of the staff working in the home. The staff who were spoken with showed understanding of the POVA procedures and showed awareness of the need to protection residents from all forms of abuse. The Branches Version 1.10 Page 16 Two residents indicated that if they have any concerns they feel confident to raise it with the manager or staff without fear of intimidation. Some residents also confirmed that they feel their rights are respected by the staff. Three other residents spoke about their past involvements in postal voting and were looking forward to receiving their postal votes for the forthcoming general elections. The manager confirmed that all residents have been registered to receive postal votes. The Branches Version 1.10 Page 17 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, 20, 21, 22, 23, 26. The home provides a safe, comfortable and pleasant setting for the residents. EVIDENCE: Since the last inspection, good progress has been made to cordon off part of the grounds where items are stored at the back of the home. Once this is completed, it would provide a more pleasant view for those residents whose rooms overlook the back of the home. Records examined showed that safety measures relating to fire and environmental health matters were being observed. The fire-log book provided evidence of regular fire alarm tests and maintenance of fire detection and fire fighting equipments. One staff member was selected at random to test her knowledge of the fire procedures in the home. She was able to describe what to do in event of discovering fire in the home. The staff training record also indicated that all staff have had fire training. There was also record of regular testing of hot water in bedrooms and bathrooms to ensure that the water temperatures remain within the recommended range. These The Branches Version 1.10 Page 18 arrangements have been maintained to ensure the safety well-being of the residents. Most of the rooms are above the minimum 12 square metres. A number of the residents who were spoken with stated that they found their rooms very comfortable and homely. Most of the residents have furnished their rooms with personal items thus ensuring homely and familiar environment for them. Residents commented that having personal belongings in their rooms make them feel like the room belongs to them. They said they like the idea of having personal possessions around them. There are sufficient communal spaces in the home to meet the needs of the residents. At the time of making the extensions to the home, the services of building control and environmental health service were sought to ensure that the home meets the standard required for multiple occupancy and for people who may have physical disabilities. The doorways and corridors are wide enough to allow easier access for people with walking aids or wheelchairs. Two residents who have mobility problems said they have no problems with accessing any part of the home including access into the garden. There are grab rails in toilets, bathrooms and corridors to assist with mobility and to promote independence. At the time of the inspection the home was noted to be clean and free from offensive odour. It was noted that all toilets had liquid soap dispensers. The laundry machines have facilities for sluicing and washing foul linen at very high temperature to avoid the spread of infection. Suitable sluices rooms are also available in the home. These arrangements had been put in place to avoid the spread of infection. The Branches Version 1.10 Page 19 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, 28, 29, 30. The home employs staff in sufficient numbers to meet the needs of the residents. The home has a robust system for recruitment of staff thus ensuring the protection of the residents in the home. EVIDENCE: The staffing rotas were examined and found to be in line with that agreed with the previous regulatory authority. The manager has some flexibility regarding the deployment of extra staff to meet the needs of the residents. Examination of past rotas showed evidence of staffing levels being over the minimum agreed. This was to take account of the changing needs of the residents, hospital appointments and outings with individual residents. The home continues to maintain a clear policy on recruitment and the manager confirmed that the home follows these policies rigorously. All the staff have been given conditions of employment and a job description. The manager confirmed that all staff have had CRB checks done, and evidence of these were made available for inspection. The manager confirmed that strict adherence to employment policies has led to the right calibre of people being employed leading to low staff turnover, which had positive benefits for the residents. The residents commented positively on having regular staff that they know well and relate to. One resident described it as “they are like family, you get to know them and they get to know you”. The Branches Version 1.10 Page 20 The staff training log was examined as part of the inspection process. The training provided for the staff included moving and handling, first aid, fire safety training, food hygiene, challenging behaviour management, falls prevention and protection of vulnerable adults awareness training. Nine of the fourteen care staff have completed NVQ 2 training. New staff are provided with induction training followed by foundation training within the first six months of employment. The manager stated that the emphasis on providing suitable training to the staff has positive impact for the residents. The good practice models observed on the day of the inspection was evidence of the good training provided. This included flexible approaches to care such as allowing sufficient time for their meals, allowing residents to rise when they want and the provision of purposeful recreational activities for the residents. The inspector observed care practices and the interaction between the staff and the residents. These showed staff treating residents with respect and dignity. The Branches Version 1.10 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35, 38, The manager provides good leadership and direction for the staff, resulting in consistently good quality care practices that benefit the residents. However, attention must be paid to health and safety issues relating to wheelchairs. EVIDENCE: Staff confirmed that they are able to approach the management to discuss any issues relating to both personal and professional matters. Two residents who were also spoken with about the general management of the home confirmed that the management staff are accessible and always available to offer support and advice. Since the last inspection the manager has received the results of questionnaires sent to residents, GPs, relatives, district nurse and other professional who have regular contacts with the home. One resident commented that she took part in the survey and found it useful. She felt the process gave her extra opportunity to express her views about the service she The Branches Version 1.10 Page 22 receives. The manager also indicated that the process gave her the opportunity to assess the quality of the service through the eyes of relatives and other professionals. It is recommended that the findings are analysed and published so that they are available to the staff, residents and the general public. This would provide further documentary evidence of the continuous improvement in care practices for the benefit of the residents. The manager has put in place safeguards to ensure that service users’ finances are properly accounted for. Records of all transactions are available for each service user. One resident who is self-caring stated that she receives her weekly personal allowance and that she is able to deal with her finances independently. The home continues to maintain proper employment policies in the recruitment of staff. A programme of induction is in place for all new staff, and completed copies were available on the staff files that we examined. As a result, a number of residents felt that they are safe in the home and that the staff provide them with good care. A number of records relating to health and safety issues in the home were examined. These include electrical maintenance test certificate, water chlorination certificate, record of water temperatures, fire log book, lift and hoist servicing records. These show evidence of servicing and maintenance being up to date. The kitchen was inspected and found to be clean and maintained to a good standard. A number of records were examined and these included record of food temperature, weekly cleaning rota, record of fridge and freezer temperatures. There were notices in the kitchen on prevention of food poisoning and food safety management system. The outcome for the residents is that they live in a safe environment. During the inspection it was noticed that on two separate occasions the staff were observed to transport residents in their wheelchairs without using the foot rests. This is considered health and safety hazard and the manager was advised to take immediate action to ensure that such practice ceases. The Branches Version 1.10 Page 23 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 x x 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 Standard No 16 17 18 Score 3 3 3 x 3 3 x 3 x x 2 The Branches Version 1.10 Page 24 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 9 Regulation 13(2) Requirement Suitable arrangments must be put in place to ensure tha access to medicines are protected at all times. The pracice of transporting residents in wheelchairs without footrests must cease. Timescale for action 12 May 2005 12 may 2005 2. 38 13(4)(c ) 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. 2. 3. Refer to Standard 2 19 33 Good Practice Recommendations All new residents should be issued with written contract/statement of terms and conditions with the home. The provider should continue to explore way to deal with the discarded materials in the ground. It is recommended that the findings are analysed and published so that they are available to the staff, residents and the general public. The Branches Version 1.10 Page 25 Commission for Social Care Inspection Baltic House Port of Tyne Tyne Dock South Shields, NE4 9PT 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 The Branches Version 1.10 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. 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