Inspection on 23/05/06 for The Hillings

This inspection was carried out on 23rd May 2006.

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 Hillings 15/10/09

The Hillings 16/01/09

The Hillings 02/11/07

The Hillings 09/05/06

The Hillings 22/09/05

The Hillings 13/05/05

The Hillings 05/10/04

The Hillings 16/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Hillings Grenville Way Eaton Socon Cambridgeshire PE19 8HZ Lead Inspector Joanne Pawson Unannounced Inspection 23rd May 2008 10:30 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 The Hillings DS0000015140.V365041.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. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Hillings Address Grenville Way Eaton Socon Cambridgeshire PE19 8HZ 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) 01480 214020 01480 475755 admin@thehillings.healthcarehomes.co.uk The Hillings Limited Manager post vacant Care Home 64 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (54) of places The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2008 Brief Description of the Service: The Hillings is situated at the end of a cul-de-sac in a quiet residential area of Eaton Socon a few minutes walk from local shops and about two miles from the busy market town of St Neots. The Hillings is registered to provide accommodation and support for 64 people. The home offers single storey accommodation in five units each comprising of single bedrooms, a lounge/dining room, kitchen, toilets and bathroom. Two of the units are for people who need extra care due to dementia (up to twenty residents) and there are several respite care places. A large conservatory links the two extra care units and is also used as an activity centre. There is a main kitchen, laundry, staff facilities and sluices. The current fees for privately funded resident’s range from £525 to £600 a week depending on the level of care provided and if the bedroom has an ensuite toilet. Funded residents’ fees range from £351 to £416. The CSCI report is made available in the foyer of the home. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection was carried out from 10:30am until 4pm. We spent time talking to the residents, the manager and looking at care plans, health and safety documents, staff recruitment, supervision and training documents, and talking to the members of staff on shift. A short observation for inspection (SOFI) was undertaken in one of the lounges. This is a tool used when people living in the home are not able to tell inspectors about the care they receive or what it is like to live in the home. The information gathered during the observation is commented on in the report. Three people were observed in one lounge for a period of two hours. Observations were made every five minutes and the most positive outcome was noted in that time. A new manager has been appointed to the home. As he has not yet been registered by the commission he will be referred to throughout this report as the acting manager. A new deputy manager has also been appointed and is due to take up the post in June. The service that the residents receive continues to improve due to the managerial, financial and training support Healthcare Homes have invested in it. What the service does well: What has improved since the last inspection? The care plans for the permanent residents have greatly improved so that staff have the information they require to meet the residents needs. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 6 Food and fluid charts are being completed so that staff can monitor residents intake where needed to ensure they are receiving sufficient food and fluids. 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 Hillings DS0000015140.V365041.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 The Hillings DS0000015140.V365041.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. People thinking about moving into the home have enough information to make an informed decision about if their needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a written statement of purpose, which explains the facilities and services the home offers, it is available in large print and audio format for residents with special needs. Assessments are completed by the staff before people move into the home and assessments by health and social care teams are also obtained to provide more information. The acting manager stated during the inspection that he The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 9 only agrees that new residents can move into the home once he has all the relevant information to ensure that the home can meet the persons needs. Prospective residents are encouraged to visit the home before they decide if they would like to live there. The Hillings DS0000015140.V365041.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. The care staff have the information they require to meet the needs of the majority of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of care plans have greatly improved since the last key inspection so that they include the information staff require to meet the residents needs. The care plans now include information about the life history of the resident, this gives the staff information that they can chat to residents about and has helped in some instances to distract residents when they have become agitated. The majority of care plans are being reviewed and updated as necessary. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 11 One care plan we looked at for a resident receiving respite care did not contain the information the staff needed. The residents daughter had supplied information about what her mother liked to drink and to what consistency (it should be thickened to prevent choking). However the resident received drinks out of a mug, plastic beaker with a spout and off a spoon; all of which seemed to be different consistencies. One resident was clearly showing signs of agitation. The residents care plan stated that she enjoyed crosswords, music, peace and quiet and often found the link room relaxing. Two of the four suggestions were offered. According to the daily notes one resident was regularly showing signs of agitation and aggression but there was evidence in the residents care plan that staff were trying to support her through this and there was a referral to the community mental health team for support and guidance. One member of staff stated that when new staff start she asks them to read through the car plans by themselves and then sits with them and goes through them again to answer any questions they may have. Personal information about a resident and their food and personal care needs was on a display on a kitchen cupboard door in one of the units. This information should be confidential to promote the dignity of the resident. A pharmacist inspector visited the home the previous week and undertook an inspection of the procedures and policies for the administration of medication (a separate report is available from the commission). It was found that there had been considerable improvements in the storage of the medication. However, keys to the medication storage room and the trolleys stored there were still kept in an unsecured key cupboard in an open office, which could pose a security risk. Controlled Drugs were being stored in a locked cupboard that would meet the Misuse of Drugs (Safe Custody) Regulations 1973 (as amended) if it were correctly secured to a solid wall. The usage of Controlled Drugs was being recorded in the Controlled Drugs register. Inspection of records of when medication is given to residents showed some improvement in their accuracy but there were still a number of unexplained omissions given no clear indication of whether residents had received their medicines or not. Hand-written entries on medication records did not always indicate the month and year of use. There are now clear guidelines for staff, kept with the medication records, particularly where medication is prescribed on a “when required” basis. The requirement made that medication must be stored safely and securely for the protection of residents and records of the administration of medicines to people who use the service must be accurate and complete to make sure they receive the medicines prescribed for them has therefore not been met in full by The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 12 the given timescale but considering the improvements made so far, this has been rolled forward with a new timescale for action. In addition to this, the medication records show that medication for one resident which had special instructions for it not to be given at the same time as other medication was recorded as being given at the same time, this was also supported by discussions with care staff. This could seriously affect the health if the resident concerned and an immediate requirement notice was served. A requirement was made for people who use the service who look after and take their own medicines to be protected by adequate risk assessments. Inspection of care records show that this requirement has been met and good clear risk assessments are now in place. A requirement was made for staff authorised to administer medicines to be trained and assessed as competent to do so. This will protect people who use the service from harm. Inspection of training records show that further training has been provided recently and assessments of competence of staff to administer medication have been completed. This requirement had therefore been met. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Daily activities could be more individual to meet the needs and likes and interests of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activities calendar was on the notice board for the week following the inspection. The timetable was Monday – bank holiday, Tuesday – no activities, Wednesday – pamper day, Thursday – crafts, Friday -music therapy (limited places) and one to one sessions in the afternoon. One resident was asked if she would like to set the table for dinner. The resident seemed to enjoy this until the member of staff walked away to do something else and the resident became concerned that she was not doing it right. On return the staff member reassured the resident that she had done a good job but the resident had lost her confidence in the task. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 14 Several residents and one relative stated that they would like more activities on the individual units (there is a day centre within the home that residents can attend). One member of staff stated that she had attended dementia training and was going to be moving to work in the dementia units and would be getting the residents involved in activities such as cooking, making their own tea, woodwork, planting in growbags and much more. One resident stated’ it has been the holiday of a lifetime’ and the staff ‘pop in to see if you are safe’. Another resident stated ‘it’s quite good here, the girls look after you, they’re always helpful and never miserable’. All of the resident’s comments about the food offered were positive. A short observation for inspection (SOFI) was undertaken in one of the lounges. This is a tool used when people living in the home are not able to tell inspectors about the care they receive or what it is like to live in the home. The three people who were observed will be referred to as Resident One, Two or Three for the purposes of this report to ensure their identities are protected. The observations are broken down into five- minute time frames, and the most positive outcome for each resident is noted. Resident one was out of the room for four of the 24 five-minute periods of assessment. One member of staff was seen standing next to resident two assisting her with breakfast rather than sitting next her to. The same carer also walked off and left the resident halfway through her breakfast without any explanation. It was also observed as part of SOFI that the carer did not talk to resident two whilst she was feeding her and just looked over her head and for part of the time was not even watching what she was doing. There was a change of staff at this point and the new staff knew the residents by name and were able to converse in English to them. It was apparent from the SOFI that out of 89 staff interactions, 73 were with residents one and three and only 16 with resident two. For this person six of those interactions were task oriented i.e. being hoisted or being given drinks. Even where this occurred there was little or no interaction between the member of staff and resident two to explain what was going on. On one occasion the staff member gave resident two three spoons of drink and then just walked off without comment or enquiring whether she wanted more drink. Out of 66 positive interactions only six were with resident two. Resident one was quite noisy and disruptive and staff sat with her and talked to calm her behaviour. Further observation in the unit showed that staff often spoke to one resident (not part of the SOFI) who was able to converse with them and was amusing. At one stage it was also noted that there were not enough chairs in the lounge The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 15 for all the residents, and staff had to find a chair. The cleaner was hoovering round peoples legs and this meant the lounge became noisy. Some of these findings were discussed with the acting manager after the inspection, although the specific figures were only compiled later. A requirement from a previous inspection to complete food charts so the intake could be monitored when needed has been met. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Residents are confident that if they complain any issues will be dealt with appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One resident stated ‘If I’m not happy with anything I would go to the office and tell them’. She went on to say that she had complained once about an agency member of staff and the staff member had not been used again. The resident also stated that the manager had asked if she was happy with everything. There were two complaints seen on file. Both had been dealt with according to the homes complaints procedure. One compliment was also seen. The Commission has not received any complaints about the home since the previous inspection. Staff were aware of the procedures to follow if they suspected a resident had been abused in anyway. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. The home is well maintained and safe place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of the home had no offensive smells except the entrance area of the evergreen unit. The acting manager stated that they were aware of the problem and had tried changing the flooring and on the day before the inspection had replaced a bed to try and alleviate the problem but further action was planned. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 18 One relative said that the home had only three hoists that have to be used throughout and therefore there are times that his relative has to wait up to one hour as the hoist is not available. He said that his relative was “anxious of being hoisted but now feels OK about it”. The entrance area of the home is welcoming with plants and flowers outside and comfortable seating and flowers in the entrance area. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Staff receive the training they require to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rotas were checked and it was found that there were five senior care staff and 9 care staff on for the am and pm shift on the day of the inspection and one senior and four agency staff due to work overnight. There was correction fluid being used on the rota where changes had been made. This must not be used in the future. One relative said they would like to see consistency in the staff as the changing carers is not helpful to those who live in the home. This was acknowledged by the acting manager who stated that he had planned to keep staff teams working in the same units. Staff were observed working with the residents throughout the inspection. The majority were seen to be caring and helpful. The member of staff The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 20 administering the medication had excellent communication skills with the residents. On arrival in one of the dementia units we tried to ask a member of staff the surname of one of the residents. The carer replied ‘I don’t know her surname or how long she has been here, I don’t usually work on this unit’. When we asked another member of staff the same question she could not tell us either and walked away. When we asked a third member of staff she replied’ I can speak English but can’t understand it very well, I have only been here a month’ but did not answer our question either. It was noted that the staff in the unit were changed after the above conversation, although the acting manager stated that this had been (as a result of the staff recognising) the communication difficulties (of the staff) with the residents with dementia. The acting manager also stated that staff whose first language is not English are supported with English courses in the home when improvement is needed. One person living in the home said that although staff understand her she does sometimes find it difficult to understand them. Three staff files and the training matrix were looked at. The files showed that all of the required recruitment checks were in place. Staff spoken to were positive about the acting managers decision for staff to only work one in one unit so that they could get to know the residents and their likes and dislikes and build relationships with them. The manager confirmed that the induction for new staff had been extended to six days training including an extra day on care delivery. All of the staff spoken to confirmed that they had the training they needed to do their job properly. The training matrix showed that with the exception of a few new staff all mandatory training was up to date. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is adequate. The processes for the running of the home are open and transparent and include input from the residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the staff spoken to were very positive about the acting manager. Comments made were ‘he’s on our wave length, we all feel supported’ and from another member of staff ‘for the first time we feel like we have guidance now and know what were aiming for’ and ‘were working more like a team’. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 22 The finances of four residents were checked and found to be correct. The administrator said that cash was left for any expenses over the weekend and then these transactions were documented on individual residents files the following week. She also said that no-one audits the financial files and this was discussed with the acting manager. The fire alarm tests were documented and there was one on the day of inspection. There was a fire safety report dated 25/03/08 on file stating the fire risk assessment was still valid. There were details of tests of the emergency lighting and fire extinguishers. Fire training had been completed on 22/01/08 when eleven staff attended. There were details of eleven accidents or incidents documented during the month of May 2008. Where appropriate the Commission had been notified. The home has resident and relative meetings and this was confirmed with a relative who attends. The files and the supervision chart in the acting managers office showed that not all staff were receiving regular supervision. One member of staff confirmed that although she felt able to speak to the manager if she had any concerns she felt she would benefit from a regular formal supervision. The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 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. 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 1 3 3 X 3 2 3 3 The Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation Requirement Timescale for action 01/07/08 12 Care plans must be updated to (1)(a)&(b) reflect the changing needs of the residents. This will ensure that the staff have the information they require to meet the needs of the residents. 13(2) 17(1)(a) Sch 3(3)(i) 2. OP9 Medication must be stored safely 30/06/08 and securely for the protection of residents. Records of the administration of medicines to people who use the service must be accurate and complete to make sure they receive the medicines prescribed for them. This requirement has been partially met therefore the timescale has been extended. 3. OP9 12(1) 13(2) Ensure medication is given appropriately to residents taking into account any special instructions for its administration. This will protect residents from harm Activities that suit the individual interests and abilities of the DS0000015140.V365041.R01.S.doc 21/05/08 4. OP12 16(2)(m) 01/08/08 The Hillings Version 5.2 Page 25 residents must be provided. This will encourage residents to take part in activities. 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 Hillings DS0000015140.V365041.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Hillings DS0000015140.V365041.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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