Inspection on 25/07/06 for The Fearnes

This inspection was carried out on 25th July 2006.

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

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

Other inspections for this house

The Fearnes 17/03/09

The Fearnes 13/08/07

The Fearnes 22/02/06

The Fearnes 06/10/05

The Fearnes 18/01/05

The Fearnes 01/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Fearnes (The) 26 Knyveton Road Bournemouth Dorset BH1 3QR Lead Inspector Martin Bayne Key Unannounced Inspection 09:00 25th July 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fearnes (The) DS0000003905.V306009.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 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. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fearnes (The) Address 26 Knyveton Road Bournemouth Dorset BH1 3QR 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) 01202 296906 01202 310065 www.care-south.co.uk Care South Mrs Margaret Houston Tomlin Care Home 40 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (40) Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 40 in the category OP including up to 30 in the category DE(E) and up to 10 in the category MD(E) Two named service users (as known to the CSCI) in the category LD may be accommodated. Two named service users (as known to the CSCI) in the category LD(E) may be accommodated. 22nd February 2006 Date of last inspection Brief Description of the Service: The local County Council built The Fearnes as a residential care home over 20 years ago. It is now part of Care South (formerly known as The Dorset Trust). The home is located in a residential area of Bournemouth close to the central shopping area and the travel interchange. The Fearnes is registered to provide care and accommodation for 40 older people and this includes 30 residents with dementia. The home is divided into four separate houses - Oak Way, Beech Way, Willow Way and Lilac Way. The three houses with residents who experience dementia have magnetic keypads fitted to the entrance to minimise the risk of wandering. Each unit has 10 bedrooms, a lounge, and a dining room and kitchen area. Assisted bathing and shower facilities are available and separate toilets are located close to residents’ bedrooms. The accommodation is available over two levels - ground floor and lower ground floor. Accommodation is provided in single bedrooms with vanity unit style washbasins fitted for use in each room. The home is decorated in a homely way and is comfortably furnished. The Fearnes is gradually being extensively refurbished and developed, current improvements include upgrading the laundry, relocating the home’s hairdressing room and improving the assisted bathing facilities in some bathrooms. The spacious and inviting entrance hallway has additional seating and a piano and provides a useful central focus to the home. The home has a passenger lift to enable easy and level access to both floors. The home has front and rear gardens with raised flower borders, mature shrubs and garden seating. A driveway to the front of the home provides off road parking. Margaret Tomlin is the registered manager and Mr Roger Fulcher is the registered individual (RI) on behalf of Care South. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the home that took place between 9:00am and 3:30pm. The aim was to follow up on the three requirements and six recommendations made at the last inspection and to evaluate the home against outcomes for the core national standards for older people. The inspection included discussions with the registered manager and deputy, a tour of the premises, speaking with the residents in one of the four units of the home and inspecting the records that the home is required to keep on how they care for the residents. Comment cards were also returned by relatives, GPs and health and social care professions that informed some of the judgements about the home. The fees for the home range from £400 to £565 per week. What the service does well: What has improved since the last inspection? The issues arising from risk assessment processes that were subject to a requirement and a recommendation at the last inspection have been addressed. The building of the new laundry area has now been completed and as from 2nd August 2006 the home will take on all the laundry needs for the home and no longer use an outside launderers. The recommendation that the home develop the recreational provision for residents has been met through the appointment of an activities coordinator for twenty hours per week. The home now has a copy of the guidance issued by the Department of Health on the protection of vulnerable adults thus meeting a recommendation made at the last inspection. A plan of the building has been posted near the front door in the interests of fire safety. This was recommended at the last inspection. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 6 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. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 The Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents benefit from an assessment of their needs being undertaken before being admitted to the home to ensure that these can be met, however the registered manager must ensure that residents are only admitted within the home’s categories of registration. EVIDENCE: The manager described the assessment process that is followed for admitting a new person to the home. Prospective residents have an assessment of their needs carried out by either the manager or the deputy manager to ensure that these can be met at the home. This is recorded on an assessment sheet. Throughout the inspection the personal files for a sample of four residents who had been admitted to the home since the time of the last inspection was used to track the paperwork that must be maintained for each resident of the home. It was found that in each case, an assessment had been carried out and recorded. The assessment sheet covered all of the topics set out in the standards for older people. Copies of care management assessments were Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 9 also obtained where a person had been referred through Social Services and used as part of the assessment process. Once a decision has been made to offer a person a place at the home, this is confirmed in writing. The home has submitted a variation to admit two people in the category of LD(E) to the home, however this is still being processed through CSCI. The home currently has a condition of registration to accommodate two named people in this category. It was found that a person in the LD category had been admitted prior to the variation being granted. The needs of this person were case tracked through the inspection and it was found that the home was meeting their needs and the person was very happy living a the home, however the importance of admitting people within the categories of registration were discussed as admitting a person out of category is an offence against the Care Standards Act 2006. The home does not provide a service for intermediate care. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning and risk assessment process are in place so that staff can meet the needs of residents. Medical needs of residents are met and medication administered in line with good practice. Residents’ privacy and dignity is respected in the home. EVIDENCE: The manager informed that the system for recording the care needs and records for residents had been changed and the home now had one working file for the use of the staff and one archive file. The care plans for the four residents tracked through the inspection were seen and it was found that a plan of care had been developed through the assessment process in conjunction with residents where they were able to participate in this process. The manager informed that relatives were also consulted particularly where residents were not able to contribute due to their mental frailty. The care plans were reviewed monthly as required and provided sufficient information for a new member of staff to offer assistance to that person. The personal files also contained key information and a photograph of the resident, together with risk assessments. At the last inspection a requirement and recommendation Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 11 were made concerning risk assessments for particular residents. It was found that the issues identified had been dealt with appropriately and risk assessments updated. For each resident a moving and handling assessment is carried out and also a comprehensive risk assessment form. Assessments are also recorded for skin care and dietary needs. Should a resident require additional monitoring concerning any other health need charts or recording systems are put in place. From the case records and speaking with residents it was evident that the health needs of residents are met with all residents being registered with a GP. The there was also evidence of the home working with CPNs, district nurses and the falls prevention team appropriately. The needs of residents concerning chiropody, eye care and hearing were also being met. The home has recently had a full pharmacy inspection through CSCI and recommendations concerning best practice have been adopted in the home. The deputy manager, who has delegated responsibility in the home for medication informed that the medication procedures were being inspected though the PCT the following week. The medication cabinet and trolley were inspected and it was found that medications were being stored correctly. Only senior staff who have received training in safe administration of medication administer medication to residents. The medication administration records for the residents tracked though the inspection were seen and it was found that there were no gaps within the record. The residents spoken with said that the staff were all very courteous and friendly. From observing the interaction between the staff and the residents it was clear that the residents were comfortable with the staff. The organisation has a strong ethos of putting the resident first and this philosophy is taught from induction training. Residents spoken with said that their dignity and privacy were respected in the home. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home tries to meet the lifestyle choices of residents and helps them exercise choice over their lives. Residents are supported to maintain contact with their families and friends. Residents are provided with a good standard of food. EVIDENCE: From speaking with the residents in one of the units there was evidence that the home tried to meet the individual needs concerning their lifestyle choices. One person who enjoyed music was being taken to two concerts with a member of staff later in the year. Another resident informed that they were supported to maintain contact with friends from another home in which they had previously lived, whilst another resident is allowed to keep a parakeet. Since the last inspection an activities co-ordinator has started working in the home for twenty hours per week. Group activities are organised within the home. A two monthly Bingo evening is also arranged to which relatives are invited. Group outings are arranged with the involvement of residents. A fete was recently organised at the home with some residents helping man some of the stalls. The activities co-ordinator has a remit to also spend time individually with the residents who do not like joining in group activities. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 13 Spiritual needs of residents are catered to and currently there is a service held in the home by a visiting clergy member every two weeks. Residents informed that they were able to receive visitors when they chose and that they were made welcome in the home. There is a resident’s phone in the reception area and residents can have a phone in their room if they choose. The home also has a portable set that residents can use. All of the residents are on the electoral role and receive their mail unopened. Those residents who are mentally frail are supported with their mail. The residents spoken with made positive comments about the standard of food provided in the home. As mentioned previously, each resident has a dietary assessment on admission to establish whether they require specialist diets, their likes and dislikes and whether they have any cultural dietary needs. Breakfast is served from 8.15am to 10.30 am. Residents have a choice of a cooked breakfast or from a range of cereals and toast. The main meal is served at lunchtime and takes place between 12.15pm and 2.30pm, with residents having a choice of two hot dishes or a cold meal. For the evening meal residents have a choice of a hot meal, sandwiches, cakes and fruit. The home works to a seasonal menu and records are maintained that provide information of what each resident has eaten. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well publicised complaints procedure and the staff having been trained in adult protection. EVIDENCE: The home maintains a log of any complaints made about the home and the actions taken to address these. Since the last inspection there has been one complaint and the manager had implemented a care plan to try and redress the problem. A written response had been written to the complainant within the timescale stipulated within the home’s procedure. The complaints procedure is displayed within the Statement of Purpose, at the front reception and also within the terms and conditions of residence. Residents and relatives are therefore informed of how to complain. The procedure complies with the guidance set out in the standards for older people. All of the staff receive training in adult protection as part of their induction to working in the home. The registered manager informed that she had also been on a recent training event. The home has all of the relevant policies and procedures for adult protection and since the last inspection has obtained a copy of the guidance from the Department of Health relating to the protection of vulnerable adults, which had been a recommendation of the last inspection. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home meets infection control standards and provides a safe environment with the exception of the risks to residents posed by the uncovered radiators. EVIDENCE: The home is set in well-maintained grounds, with car parking at the front of the home and a large enclosed garden at the rear to which all the residents have access. The home has a spacious front entrance the leads to the four units each accommodating ten residents. The units have their own communal areas of lounge dining area and bathrooms and cater to residents with differing needs. Oak unit is for residents with mild dementia, Beech unit for residents who present with challenging behaviour, Lilac for people with more advanced illness and who have greater personal care needs. Lilac unit is for residents who fall into the category of frail elderly. The three units that cater for people with dementia each have a locked door policy in order to protect residents from wandering and getting lost from the home. This is clearly documented within the Statement of Purpose. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 16 The kitchens for the home are located in one of the units. At the last inspection the home was required to risk assess the hot trolleys that are used to transport the food to the other units. This has been carried out and covers have been bought to protect residents from the hot surface of the trolleys. The home has many uncovered radiators. These have been risk assessed individually with reference to all the residents and some have been covered. National Minimum Standards state that residents should be protected from the risk of burns by these being covered. Where risk assessments have indicated that there is risk to residents, these radiators must be covered. The judgement of the inspector was that uncovered radiators in residents’ rooms particularly where chairs were positioned were a significant risk and should be covered. All the hot water outlets of the baths have thermostatic mixer valves fitted to protect residents from scalding water. The home has in the past contracted laundry services to outside launderers. The home has now finished work on its own laundry facility that is equipped with commercial washers and driers and the area complying with standards. From August 2nd the home will cater for all laundry within the home and meets the requirement made at the last inspection. The home has policies and procedures for infection control and the staff are provided with protective clothing. Alcohol gels are available in the home. There are sluicing facilities within each unit for the cleaning of commodes. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents needs are met through sufficient numbers of staff who are trained and subject to all the required recruitment checks. EVIDENCE: The home continues to provide that same levels of staffing as at the time of the last inspection. There are seven staff on duty throughout the daytime from 7.15 – 22.00 and during the night time there are 3 awake members of staff on duty. In addition to the above staffing there is a senior carer on duty and during the weekdays the manager and deputy are on duty. Staff duty rosters were seen that reflected these levels of staffing. The home also employs ancillary staff of a laundry assistant between 9.30 to 15.30 seven days a week, domestics for 80 hours a week, a chef and assistant chef, kitchen assistants for 69 hours a week, an activities co-ordinator for 20 a week and an administrator for 20 hours a week. The manager said that the needs of the residents were met through these levels of staffing and that levels of staffing were reviewed based on the needs of the residents. At the time of the last inspection the percentage of staff who had been trained in NVQ level 2 was 27 . This has now improved to 33 . The manager informed that more staff were currently undertaking this training and new members of staff were put on the list to be put forward. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 18 The staff recruitment records for two members of staff who had been recruited to the organisation since the time of the last inspection were seen and it was found that thorough recruitment practices had been followed with all the required checks having been undertaken before the staff had started working in the home. New staff receive induction training that is compliant with best practice guidelines. The home provides core mandatory training to staff in health and safety, moving and handling, infection control, basic food hygiene, first aid and adult protection. There is also a range of other care related courses to which staff can be nominated. The organisation provides good standards of training to the staff. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and safety is promoted within a well managed home. Where residents deposit money for safe keeping at the home this is well documented. The home is run in the interests of the residents. EVIDENCE: Mrs Tomlin, the registered manager has had many years experience of managing homes within the organisation. She is currently undertaking NVQ level 4 in care and has management qualifications. The organisation has undertaken resident and relative surveys as part of its quality assurance procedures. In general it was found that the home was run in the interests of the residents with a strong ethos of a resident lead service. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 20 The home safe keeps small sums of money for many of the residents. The records were detailed with all transactions entered and a running balance of money held. A sample of three residents’ financial records was checked and the money tallied with the record. The home is not appointee for any residents. The fire log book was inspected and it was found that the checks and inspections had been carried out to the required timescale. A sample of other records of the servicing of equipment was checked, such as the boiler, portable electrical equipment wiring and the hoists, and it was found that these had been undertaken as required. Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X X 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 Standard No Score 16 3 17 X 18 3 1 X X X X 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 3 X 3 X 3 X X 3 Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 22 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 Where risk assessments of uncovered radiators indicate a risk to residents these must be covered. Timescale for action 01/12/06 1. OP19 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. Refer to Standard Good Practice Recommendations Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Fearnes (The) DS0000003905.V306009.R01.S.doc Version 5.2 Page 24 - 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. 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