Inspection on 17/04/07 for The Coach House

This inspection was carried out on 17th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Coach House 11/07/06

The Coach House 04/10/05

The Coach House 28/04/05

The Coach House 15/11/04

The Coach House 10/05/04

The Coach House 18/02/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Coach House 15 Mansion Row Brompton Gillingham Kent ME7 5SE Lead Inspector Robert Pettiford Key Unannounced Inspection 17th April 2007 10:30 The Coach House DS0000028938.V331661.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 The Coach House DS0000028938.V331661.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. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Coach House Address 15 Mansion Row Brompton Gillingham Kent ME7 5SE 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) Kent Assessment Training Services (Medway) Post Vacant Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2006 Brief Description of the Service: The Coach House is a small 3-bedded house sited in the grounds of Mansion House, a 15 bedded unit, offering 24 hour care to adults who have a learning disability. The Coach House is registered for younger adults with mental health issues and was empty up until October 2006. Service User’s accommodation is provided on 2 floors, the ground floor consists of a compact open plan living area, which comprises of sitting room, dining space with a kitchen area, plus one bedroom which is currently used as a sleep in room for staff. The 1st floor consists of 2 single bedrooms and a bathroom with toilet facilities. The Coach House is located in a quiet residential road in Brompton on the outskirts of Chatham and Gillingham town centres. It is close to public transport links and other local amenities. Fees are according to assessment of needs and services provided. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on the 17th April 2007. The Inspector agreed and explained the inspection process with the deputy manager who was present during the inspection. Documentation and records were read. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. The focus of the inspection was to assess The Coach House in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Younger Adults. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Currently only one service user lives at the home who is supported by one member of staff 24 hours per day. The home was mothballed up until late last year refurbished and re opened in October 2006 following consultation with the Commission. The inspector spent time speaking with the service user, which gave him a good opportunity to discuss the quality of care within the home and activities enjoyed. Comments were sought from healthcare professionals and others. Any comments received have been taken into account in writing this report. What the service does well: The service is currently set up to meet the needs of one service user and excels at providing this. The home provides many opportunities for the service user to express herself, and to have freedom of choice and atomony over her life. Staff also enable her to have opportunities to maintain and develop social, emotional, communication and independent living skills. Following discussions with the Service user she expressed an opinion that she takes an active part in community and feels part of it. The Coach House provides comfortable spacious accommodation, which is furnished to a good standard. Evidence gathered during the inspection process confirmed that the service user has the benefit of living in a home which is suitable for her needs and provides a warm homely environment. The service user confirmed that the staff are very caring and kind to her at all times. The inspector noted that staff spoke to her in a respectful and courteous manner. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Coach House DS0000028938.V331661.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 The Coach House DS0000028938.V331661.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective service user’s on the whole have all the information they need to make an informed choice about whether they wish to live at the home and can be confident that their needs will be suitably assessed and be offered a trial period before moving in. EVIDENCE: The home provides a statement of purpose that clearly sets out the objectives and philosophy of the service supported by a resident guide that summarises the statement of purpose and provides clear information about the home. The guide shows what the prospective resident can expect and gives a detailed account of the accommodation, qualifications and experience of staff. The manager present at the inspection confirmed that the statement of purpose includes all the information as per Schedule 1 of the Care Home Regulations 2001. The service consults the assessment information to see if they can meet the prospective service user needs before they make the decision to accept the application for admission and offer a placement. Evidence showed that prospective service users have a needs assessment carried out before they are The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 9 admitted to the home, but did not contain all of the required information. The inspector requested that it reviews it admission criteria to ensure that it contains all of the required information as required of the standards. The managers confirmed that the home encourages prospective service user’s to come to the home for the day and have a meal, they also invite for an overnight stay. All service user’s coming into the home do so on a trail basis, during this time the assessment continues and the service user has the opportunity to see if they are happy at the home. If at the end of this period the home feels it can meet the service user’s needs and the service user is happy then the placement can become permanent. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Service user can feel confident that she will have good outcomes with regard to quality of care. The Service user can feel assured that she will be treated with respect and dignity and her rights to make decisions about her life are respected. She has the opportunity to be consulted on, participate in, all aspects of life within the home as her wishes and capacity allows and is supported to take risks. EVIDENCE: The inspector viewed and discussed with the manager present at the inspection the care records relating to the service user living at the home. In the care plan viewed there was good detail and guidelines in respect of the support needed to fully meet her needs. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 11 Following discussion with the service user she confirmed that she was fully involved in drawing up her personal care plan. She also confirmed that she is empowered to make changes to her care plan to meet her needs. It was evidenced following observations made, discussions with the service user and staff that the quality of care was of a good standard, the care planning system has a centred planning approach which has a holistic model as it’s base. The care planning approach is one with includes social and personal goals including hopes and aspirations. However the home needs to carry out an assessment of daily living skills to ensure the service user is support to maintain and learn new skills. It is presented in a format that ensures the service user can access and understand the information it contains. It is written in plain language, is easy to understand and considers all areas of the individual’s life including health; specialist treatments, personal and social care needs. Staff have skills and ability to support and encourage the service user to be involved in the ongoing development of her plan. Staff make the process interesting, using a variety of ways to enable her to make a worthwhile contribution. A key worker system enables staff to establish special relationships and work on a one to one basis. Risk assessments sampled were detailed with regard to identifying the risk and the control measures needed to minimise risks. The managers present are committed to ensure that all service users have comprehensive risk assessments to minimise risk. The inspector visited the home at 10:30AM. During the inspection the inspector noted that the service user was seen making choices about her life and were seen to be part of the decision process. A relaxed atmosphere was noted with the service user interacting with staff. The inspector also had the opportunity at length to the service user who expressed a great deal of satisfaction with the care offered and given. She felt that the home offered an inclusive family atmosphere and that the management team were receptive to her comments and suggestions. Facilities and procedures at the home seek to ensure service users privacy and dignity at all times and when providing health and personal care. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is Excellent This judgement has been made using available evidence including a visit to this service. The Service user’s social and recreational interest and needs are well provided for with a wide range of activities organised and she is supported to maintain contact with family, which ensures she continue to receive stimulation and emotional support. The dietary needs are well catered for and her views and opinions are sought regarding the choice of meals served. The service user can feel confident that she is enabled to exercise choice and control over her life. EVIDENCE: The service user is able to enjoy a full and stimulating life style with a variety of options to choose from. The home has sought the views of the service user and considered her interests and abilities when planning the routines of daily living and arranging activities. Routines are very flexible and the service user can make choices in major areas of her life. The routines, activities and plans The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 13 are service user focussed, regularly reviewed, and can be quickly changed to meet individual needs. The service user is actively encouraged to keep in contact with family. Visitors are welcome at any time should the service user so wish and facilities are available for them to have a drink or a meal. The service users can choose to entertain visitors in her own room or the lounge or garden areas. The system in place and the practice and attitude of the staff team give the service user the opportunity and support to remain independent. From observation and discussion with the service user that she is offered a choice of menus that meet her dietary needs and individual preferences. Meal times are flexible to suit her activities and schedules. She is able to choose where to eat, and also have facility to make drinks, meals and snacks. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users feel supported by the level of help given and that their healthcare needs are addressed. The service user can feel confident that their wellbeing will be protected by the home’s policy and procedures with regard to the handling and administration of medication. EVIDENCE: Times of getting up / going to bed, having baths, eating meals and other activities are flexible to allow for different service users daily routines. The service user was able to make her own choice where possible with regards to what they wished to wear this was evident by her individual appearance. The inspector observed excellent interaction between staff and the service user. The homes records fully documented all physical and emotional healthcare needs which is monitored on a daily basis. Records of health care provided by G.P, chiropodist, dentist, and opticians were evidenced. This system ensures The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 15 that all Service Users receive continuity of care and support and that potential complications and problems are recognised and dealt with at an early stage. The inspector viewed the care records and specific health care records relating to the service user. Records viewed however did confirm that service user’s had access to a range of health care inputs as and when required but not as part of regular health checks. The documentation seen confirmed that the service user had a Doctor and visits to other health professionals are arranged and enabled. The health care issues were seen recorded in the daily record. The home was requested to review its practice in respect of pro-active healthcare. The inspector viewed the storage arrangements and some records including Medication Administration Record (MAR) sheets, and the protocols for the administration of “PRN/As Required” Medication. The medication was seen to be stored appropriately and administered in accordance to current guidance. The manager present was requested to include a signature sheet to the folder containing the MAR sheets to identify the member of staff giving the medication. The manager confirmed that all staff who dispense medication have received appropriate training and that the recording and administration of medication follows The Royal Pharmaceutical Society guidelines (amended June 2003). The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service user can not feel fully confident that she is aware on how to make a complaint and that systems are in place. The service user however is protected by robust adult protection policies and procedures EVIDENCE: A copy of the Home’s complaints procedures was not available within the home that meets with the National Minimum Standards and in a format that the service user could understand. The home currently uses the company complaints procedure. However it did not make reference that the service is regulated by the Commission for Social Care Inspection or contain the required elements as per the standards. The service user when spoken with was not aware of any complaints procedure, but felt confident that she could raise any concerns with staff. The manager present confirmed that this shortfall would be addressed as a priority. No requirement therefore has been made at this time. The home’s Policy for the Protection of service users and staff “Whistle blowing” procedure were discussed. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training has not been provided. The The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 17 home did possess a copy of the Kent and Medway Adult Protection procedures / Protocols. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service user’s benefit from living in a home that provides for a homely environment which has safe access to comfortable indoor and outdoor communal areas. The standards of internal and external decoration were found to be of a good quality. EVIDENCE: The management and staff encourage the service user to see the home as her own home. It provides a very well maintained, safe, comfortable, attractive environment which has all the facilities to meet the service users needs. At present only one service user is living at the home, It is hoped that when the home becomes full all service user’s will experience the same outcomes. The home is well lit, clean and tidy and smells fresh. The management has a proactive infection control policy. Staff wear protective gloves when providing personal. The laundry room is situated next to the kitchen downstairs and is in The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 19 an appropriate environment. The washing machines meets the needs of the service user and promotes her independence and daily living skills. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service user’s can feel confident that her care, social and emotional needs are fully promoted by the employment of care staff in sufficient numbers to meet her needs at all times and trained on the whole to the required standards. The service user is fully protected by the recruitment procedures within the home. EVIDENCE: The ratios of care staff to service user’s is determined according to the assessed needs of the service user. One member of staff is on duty 24hrs per day. Following discussions with the manager present, a review of the rota and observations made during the inspection. The inspector is of the opinion that sufficient care staff were on duty to support the service user to participate in activities, meet their personal needs and take all reasonable steps to ensure their health and safety at all times. Evidence at time of the inspection however The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 21 confirmed that their immediate needs were being meet and that the service users spoken with were happy and content. The staff training records indicated undertaken training. Individual and group staff training needs had been identified. From documentary evidence seen the standard of staff training was good overall with the majority of staff completing basic courses and NVQ (National Vocational Qualification) Level 2 or above care qualification. Updates and training needs have been identified and actioned. Feedback from other healthcare professionals indicated that additional training in mental health would be an asset. The inspector spoke with the manager with regard to meeting the needs of the service user. The manager stated that additional training would be sought. No requirement has been made at this time. The manager confirmed that the home has a development programme for all new staff, which meets Sector Skill’s council’s workforce training targets and ensures staff fulfill the aims of the home and meet the changing needs of service user’s, and that all members of staff receive induction training to specification within 6 weeks of appointment to their posts, and foundation training within 6 months. The home showed that it undertakes a recruitment practice including submission of an application form detailing all previous work history, requests proof of identity and copies of qualification certificates, seeks two written references, and confirms work status. The home’s recruitment files sampled were seen to include all the information as required under schedule 2 of the Care Home Regulations 2001. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome group is good The service user benefits from living in a well run and managed home. The service user and their relatives can feel confident that their views and opinions effect how the home is run but no formal quality assurance system was found to be in place. The service user can feel confident that the home has taken the appropriate steps to safeguard her health and safety. EVIDENCE: The manager is actively involved in the day-to-day management of the home and works with staff and the service user. The manager has the experience and is competent to run the home. She works to continuously improve the service and provide an increased quality of life for the service user. There is a strong ethos of being open and transparent in all areas of running of the home. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 23 From observation and staff feedback the manager offers a clear sense of direction and leadership, which staff and service user understands. The home operates a keyworker system to identify an individual staff member to directly to work with a service user on a one to one basis. The provider carries out Regulation 26 visits to monitor the standards of care within the home and the service user is able and feels confident advising the home should any problems be identified. At present the home does not have a formal quality assurance system. The manager stated that a new quality assurance / auditing tool is being introduced that will meet with the standards. No requirements have been made at this time. Health and safety was not inspected at the time of inspection. However the home has only recently been re-opened in October 2006 and was found at that time to meet with the standards with regard to health and safety. The manager stated that health and safety is a priority and that it is monitored on a regular basis. Therefore the judgement has been made on that basis. The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 3 4 3 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 3 x The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Coach House DS0000028938.V331661.R01.S.doc Version 5.2 Page 27 - 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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