Inspection on 29/05/08 for The Manse

This inspection was carried out on 29th May 2008.

CSCI found this care home to be providing an Adequate service.

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 Manse 04/09/07

The Manse 09/05/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE The Manse 11 South Norwood Hill South Norwood London SE25 6AA Lead Inspector Mohammad Peerbux Key Unannounced Inspection 29th May and 3rd June 2008 09:00 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 Manse DS0000067467.V364235.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 Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manse Address 11 South Norwood Hill South Norwood London SE25 6AA 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) 020 8771 2832 020 8771 4506 veronica.mccleary@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd Ms Veronica McCleary Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 29 4th September 2007 Date of last inspection Brief Description of the Service: The Manse is registered with the Commission for Social Care and Inspection to provide personal care for up to twenty-nine older adults. The property is a purpose built residential care home located in the centre of South Norwood close to local shops, eateries and good public transport links. The home shares the site with a sheltered housing scheme, which is also managed by the Registered manager. The home has plenty of communal space, which includes a large lounge/dining room on the ground floor, and much smaller lounge/dinning rooms with kitchenettes attached on the first and second floors. The service has its own laundry room on the first floor and a garden patio with tables and chairs. The range of weekly fees is between £432 and £550 and this information was gathered on the day of the inspection (29/05/08). The Manse DS0000067467.V364235.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 one star. This means the people who use this service experience adequate quality outcomes. This unannounced visit to the home was undertaken as a part of the inspection process for the year 2008/2009. In writing the report, consideration has also been given to information received throughout the year such as comments from people who use the service, reports of incidents and complaints. This is the first key unannounced inspection for the year 2008/2009.This inspection was facilitated by the Registered Manager and a Team Leader. Some of the residents were spoken to and they commented positively on the care they are receiving. One resident stated, “Staff are very nice and treat you very good here ”. They are all thanked for their time and all of those who provided feedback for their support in the inspection process. A tour of the building was also carried out. All registered adult services are now required to fill in an annual quality assurance assessment (AQAA) .It is a self-assessment that the provider (owner) must complete every year. The completed assessment is used to show how well the service is delivering good outcomes for the people using it. Some information from this AQAA is included in the report. What the service does well: What has improved since the last inspection? The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 6 There has been improvement made with regards to pre admission needs assessment and care planning. COSHH materials are now being kept locked. This is in accordance to Control of Substances Hazardous to Health Regulations (COSHH) 1999. Food products were checked and it was observed that they are being covered appropriately and dated to state when they were opened/cooked. 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 Manse DS0000067467.V364235.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 Manse DS0000067467.V364235.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): 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes an assessment of the healthcare needs of residents prior to their admission to ensure that their needs would be met. EVIDENCE: The home considers the needs assessment for each prospective resident before agreeing admission to the home. Three residents’ files were sampled at random and they all had a pre-admission assessment carried out. These were generally undertaken satisfactorily. Prospective residents and their families are encouraged to visit the home. Where they are invited they have opportunity to freely meet staff, visit the building and have opportunity to talk to other people who use the service or their families to find out more about it. Intermediate care for rehabilitation and return to the community is not provided by this home. The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 9 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 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally, residents’ care plans include detailed information about their needs and personal goals. This helps staff to know the residents’ needs and how to meet them. However the system for administration of medication is inadequate and potentially places residents at risk. EVIDENCE: The care plans for three residents were sampled at random and it was noted that there has been improvement made with regards to the standard of care planning. Generally care plans now cover all aspects of the residents’ health, personal and social care needs. This is in line with a requirement made at the last inspection. The manager informed that the home is in the process of introducing new care plans for all residents. It was previously required that residents’ plans are reviewed at least once a month, updated to reflect changing needs and current objectives for health and The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 10 personal care of the residents. It was positively noted that reviews are being carried out on a regular basis. However while talking to one resident, she informed that she had recently been to hospital to have some treatment and on checking her care plan, this was not recorded. This was discussed with the manager and the care plan was updated accordingly on the day of the inspection. Changes in people individual health care needs must be made aware to all staff and recorded to ensure they receive support and care as needed. The home actively promotes the residents’ right of access to the health and remedial services that they need, both within the home and in the community. However as mentioned above changes in people health care needs are not always recorded and/or updated so it would difficult for staff to meet residents’ needs fully. The medication administration records were audited. There were three instances where prescribed medication had been administered but not signed for. The team leader on duty confirmed that the medication had been administered on those three days however none of the staff have signed for them. The administration/non-administration of all medication must be recorded accurately at all times to ensure that the residents are having/not having their medication for their health and wellbeing. The team leader stated that the reason the medications were not signed for is that no one had sign for them previously. This is poor practice, as staff should always check and ensure that people using the service are having all their medication as prescribed and not just follow other signatures on the MAR sheets as this may lead to errors and mishandling of medication. The Commission is concerned that despite medication audits being carried out on a weekly basis by senior staff, those missing signatures were not identified. None of the other staff that administer medication in the home had noted those missing signatures either. The Commission is also very concerned as it was noted at the end of the inspection that the team leader on duty had signed in one of three spaces on the MAR sheet where there were three missing signatures that morning. All staff are reminded that they must make an accurate record, immediately after observing a resident taking or refusing their medicines. It was also noted that home did not have a record of receipt of all medication to the home. The team leader stated that they receive medication on a weekly basis and it is difficult to record this on the MAR sheets, as there are spaces to sign for 4 weeks worth of medication only. This was discussed with the manager and it was agreed that a separate record would be kept. All medication being received in the home must be recorded accurately to ensure that there is no mishandling. The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 11 One of the residents administers her own medications however no risk assessment was available regarding this. All residents who are able to selfadminister medication must have a risk assessment carried out to ensure that they are administering their medication as prescribed. The manager informed that most of the staff have attended medication training and an accredited pharmacist provides the training. Staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms. Residents who were spoken to stated that they are happy with the way that the staff deliver their care and respect their dignity. One resident stated, “They treat you very well here”. Another resident stated, “ The staff are very nice”. Observation of the staff team interacting with the residents showed that the carers were mindful how they addressed residents, and they were seen to be polite and friendly. The Manse DS0000067467.V364235.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are being provided with a range of opportunities for recreational and social activity that is in accord with their social and cultural needs. Dietary needs are well catered for and a well balanced diet is provided, to ensure health and enjoyment of food however the food records are not always up to date. EVIDENCE: Staff are aware of the need to plan the routines and activities of the home in a way, which meets the choice, and wishes of residents. The home tries to be flexible and attempts to provide a service, which is as individual as possible by using its staff and resources effectively. As far as possible the residents are consulted on how the home can work to provide them with a flexible lifestyle, and to achieve their wishes. The manager stated that one resident goes to church on a regular basis and there are also church services in the home for other residents. The home is in the process of employing a part time activities coordinator. The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 13 The home has open visiting arrangements and residents know they can entertain their family and friends in their own room. If they prefer they can use communal areas of the home to talk to visitors. It is clear that the home encourages individuals and groups from the community to visit the home. The service is committed to the principles of inclusion and promotes and fosters good relationships with neighbours and other members of the community. Maintaining independence and enabling residents to make their own decisions about how they wish to live is a key objective of the home. Residents have the choice to bring personal possessions with them on admission to the home and are encouraged to keep personal items, which are important to them in their own room. The “Personalisation” of individual bedrooms is encouraged. It was clear from the menus that a wide variety of different food options were available in the home with a lot of consideration given to the nutritional value of the meals provided. Staff are ready to offer assistance in eating where necessary, discreetly, sensitively and individually, while independent eating is encouraged for as long as possible. The cook consults with residents and tries to meet the preferences and suggested dishes when preparing the menu. It was positively noted that the menu is incorporated to reflect ethnic minority residents’ choices. However it was identified that the daily food records of what each resident had eaten, were not always dated so it would difficult to ascertain when they had these food. The home needs to keep an accurate and up to date record of what the residents have eaten so that their diet could be monitored especially for people who are on special diets. During the inspection it was also noted that two food products have passed their use by dates. This could potentially results to serious repercussions to the health and welfare of residents. There must be a system in place to ensure that food products are checked on regular basis for their use by date so that people using the service are not put at risk. The Manse DS0000067467.V364235.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are generally managed well, which should ensure that residents’ and relatives’ concerns are listened to. EVIDENCE: The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. Residents and others involved with the service say that they are happy with the service provided, feel safe and well supported by an organisation that has their protection and safety as a priority. The home has a complaints procedure that generally meets the national minimum standards and regulations. It keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The home understands the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. The outcomes from any referral are managed well and issues resolved to the satisfaction of all involved. Since the last inspection there has been one alleged abuse, this has been investigated and was not upheld. Training of staff in The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 15 safeguarding is regularly arranged to ensure the safety and well being of the people using the service. The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 16 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 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally hygienic and clean, homely and comfortable; this environment therefore facilitates the residents’ health and emotional wellbeing. EVIDENCE: The home is suitable for its stated purpose. It is accessible, meet residents’ individual and collective needs in a comfortable and homely way. Residents’ bedrooms are personalised to reflect their individual needs, and personalities. Overall the home was decorated to a good standard throughout and appeared to be very comfortable, bright and warm. The home has a rolling maintenance programme in place. The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 17 The home is kept clean and hygienic and free from offensive odours throughout. Systems are in place to control infection in accordance with relevant legislation and published professional guidance. However it was noted that the flycatcher in the kitchen was not working and had been “out of order” since the beginning of the month. There was a fly flying around the kitchen when this was noted. This potentially places residents at risk (see standard 38) as flies can contaminate foodstuffs, bite people and spread diseases. The manager was advised to ensure that the flycatcher is repaired within 48 hours. A follow up visit was carried out and a new flycatcher had been installed. The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 18 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 and 30 People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has the numbers and skill mix of staff sufficient to meet residents’ needs and ensure their safety however there are some gaps in the training programme. EVIDENCE: People have confidence in the staff who care for them. Copies of staff rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the residents. The registered manager informed that more than 50 of staff have an NVQ level qualification at level 2. Recruitment procedures seemed appropriate. Three staff files were examined at random and found to contain all the information required by the Care Homes Regulations 2001 including a completed job application, terms and conditions of employment, an enhanced CRB check and proof of their identity. The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 19 From the staff training records, it was noted that they were not always up to date and there are gaps in mandatory training. It was very difficult to ascertain if the staff were up to date with their training. All staff must receive relevant training that is focussed on delivering improved outcomes for residents and meets any statutory requirements and the NMS. This will ensure that staff working with people who use the service are skilled in their role and are consistently able to meet their needs. The manager is aware that there are some gaps in the training programme and plans to deal with this. The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 20 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): 31,33,35 and 38 People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home management generally provides guidance and direction to staff to ensure residents receive consistent quality care. There is a quality monitoring system and this ensures the home is run in a way that is in the best interests of the residents. EVIDENCE: The registered manager has the required experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. There is a strong ethos of being open and The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 21 transparent in all areas of running of the home. She is also aware of current developments both nationally and by CSCI and plans the service accordingly. Effective quality assurance and quality monitoring systems, based on seeking the views of residents, are in place to measure success in meeting the aims, objectives and statement of purpose of the home. The registered manager informed that small amounts of money are kept in separate envelopes for each resident with a running balance sheet appropriately maintained for sundries, such as hairdressing costs. A sample of these was seen and was accurate and well maintained. Checks show that records are generally up to date however medication administration records are not being signed immediately when items of medication are being administered by staff. All records in the home must be kept accurate and up to date at all times to ensure that residents’ rights and best interests are being safeguarded. Records with regards to health and safety are of a good standard and are routinely completed. Certificates relating to health and safety were up to date servicing certificates. One health and safety issue arose during this inspection. It was noted that the flycatcher in the kitchen was not working and could pose a risk to the health and well being of the resident. All equipment provided at the care home for use by people who use the service or persons who work at the care home must be maintained in good working order for their safety and well being. The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 The Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 23 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 15 (2)(b)(c) Requirement Changes in people individual health care needs must be made aware to all staff and recorded to ensure they receive support and care as needed. The administration/nonadministration of all medication must be recorded accurately at all times to ensure that the residents are having/not having their medication for their health and wellbeing. Timescale for action 29/06/08 2. OP9 13(2) 29/06/08 3. OP9 13(2) All medication being received in 29/06/08 the home must be recorded accurately to ensure that there is no mishandling. All residents who are able to 29/06/08 self-administer medication must have a risk assessment carried out to ensure that they are administering their medication as prescribed. The home needs to keep an accurate and up to date record of what the residents have eaten DS0000067467.V364235.R01.S.doc 4. OP9 13(2) 5. OP15 17(1) 29/06/08 The Manse Version 5.2 Page 24 so that their diet could be monitored especially for people who are on special diets. 6. OP15 13(4) There must be a system in place to ensure that food products are checked on regular basis for their use by date so that people using the service are not put at risk. All staff must receive relevant training that is focussed on delivering improved outcomes for residents and meets any statutory requirements and the NMS. All records in the home must be kept accurate and up to date at all times to ensure that residents’ rights and best interests are being safeguarded. 29/06/08 7. OP30 18(1) 29/08/08 8. OP37 17(1)-(3) 29/06/08 9. OP38 13(4) All equipment provided at the 29/06/08 care home for use by people who use the service or persons who work at the care home must be maintained in good working order for their safety and well being. 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 Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 25 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 Manse DS0000067467.V364235.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!