Inspection on 14/06/06 for The Maples

This inspection was carried out on 14th June 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Maples 18/10/07

The Maples 12/01/06

The Maples 27/04/05

The Maples 08/12/04

The Maples 27/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Maples 327 Hoylake Road Moreton Wirral CH46 ORN Lead Inspector Helen Carton Unannounced Inspection 14 & 29th June 2006 09:30 th The Maples DS0000018946.V291519.R01.S.doc Version 5.1 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 Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Maples Address 327 Hoylake Road Moreton Wirral CH46 ORN 0151 678 6956 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) www.c-i-c.co.uk. Community Integrated Care Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user over 65 years of age may be accommodated Date of last inspection 12th January 2006 Brief Description of the Service: The Maples is situated by Moreton Cross on the Wirral and is close to the main shopping area. The home is a dormer bungalow with single bedroom accommodation being provided on both the ground and first floor. A bathroom with toilet and a separate shower room is provided on the ground floor with a further toilet situated on the first floor. There is a separate dining room that is also used as a quiet seating area at the rear of the building and a lounge situated at the front of the home. The home has equipment and adaptations in place to meet the assessed needs of the service users accommodated. There is a limited amount of off road parking available to the front of the home and a large garden to the rear. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two site visits were made to the home as part of the key inspection the inspector spent approximately 9 hours in the home. Time was spent sitting and talking with residents and observing the day-to-day routines of the home and the support staff as they provided support. The inspector looked around the building to assess its suitability to provide a comfortable, safe and homely environment for the enjoyment of all residents. A selection of records kept where looked at and the inspector also checked that the requirements made at the last inspection had been completed. The main focus of the inspection process was to understand how the home was meeting the needs of the service users and how well staff were themselves supported by the organisation to make sure they had the skills, training and support to meet the needs of the residents. There is currently no registered manager in post although it is expected that an application will be made to the Commission within a few weeks. The acting manager is an appropriately qualified and experienced manager. What the service does well: The Maples provides a comfortable relaxed environment for residents to live in. The Organisation who owns and runs the home, are committed to providing training for the staff team to enable them to provide appropriate care and support to residents. The home supports residents to access health care services so their health needs can be catered for. The inspector observed members of the staff team interacting with residents in a positive and supportive manner. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the service. The home’s Statement of Purpose and Service User Guide provide good information about the care and support they can offer. Contractual arrangements and responsibilities between the organisation and residents should be more transparent to fully safeguard the residents. EVIDENCE: Residents living at The Maples have complex needs resulting in all five adults having difficulty in communicating their needs, preferences and wishes to others. They have all lived in the home for a number of years. Since the last inspection visit the home’s newly appointed service manager has reviewed The Maples Statement of Purpose and Service User Guide and has made amendments. These changes have made both documents accurately reflect the care, support and services that can be provided by the home. Residents’ contracts have a section, which requires residents’ to agree as part of the overall contractual arrangement to make a financial contribution to the purchase and maintenance of a minibus. Added to this is individual Consumer Hire Agreements, which state,” the vehicle referred to in Clause 4.1 will remain our (the owners) property at all times and can never become yours. You must The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 9 not sell or dispose of the vehicle”. Employees of CIC signed these documents on behalf of residents with no documentary evidence that any attempt had been made to involve family members or independent advocates. Or that a range of options had been considered to ensure residents are receiving best value for money with regard to transport needs. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. Care planning systems and risk management strategies are good with residents supported to be central to any decision making about how they live their daily lives. The organisation’s practices with regard to some aspects of the financial arrangements do not support and value residents’ rights as citizens and appear contrary to their policies, procedures and values. EVIDENCE: Since the last inspection visit the service manager has reviewed all information held about residents including care plans and risk assessments. As a result of this review more detailed easily readable care and risk management plans are being produced. At the time of the inspection visit the inspector viewed three residents’ files that had the new plans in place. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 11 The care plans provide the staff team with detailed information and clear guidance as to the type and level of support residents need regarding their personal care needs. The plans also provide detailed and individualised information about what makes the residents happy, sad, frightened and angry. The plans build a picture of the important things to residents including those things that are non negotiable in residents daily lives. Risk assessment information is very detailed and provides the staff team with clear guidance and where appropriate instructions as to the support and supervision residents require in a range of environments and situations. The inspector discussed the new care and risk assessment plans with members of the staff team who made the following comments: “ With the old plans I always worried that if I left other staff or agency staff they would not be able to look after her properly. Because they don’t know her way I do. Now the plans are so detailed I know everyone knows her and could keep her safe and support her in a way that makes her comfortable.” “ The new plans are much better and L involved us in setting them up and said we know all sorts of information about residents the little things that make a difference such favourite drinks, music places they like to visit. I feel we all know the residents better through reviewing and changing the plans.” Earlier in this report the issue of how residents monies are spent regarding transport provision and the amount of involvement they or their supporters have in the decision-making are raised. CIC have produced detailed policies and procedures regarding how to support residents and to ensure their rights as citizens are safeguarded. However the current arrangements for the provision of transport for residents does not reflect organisation’s values. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The home has begun to recognise and value the importance of social and therapeutic activities for residents to maintain their emotional and mental wellbeing. EVIDENCE: Since the last inspection visit the service manager and the home manager have reviewed the activities and community involvement of residents. Resulting in all residents accessing local community facilities such as cafes, shops and pubs on a daily basis. As part of the overall review of the home activities enjoyed by residents in the past are being revisited such as horse riding, sensory activities and swimming to see if they are still achievable for individuals. The service manager and home manager acknowledge further work is needed to ensure residents regularly engage in enjoyable and worthwhile activities and The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 13 that they are reviewed. To ensure residents are given positive options and are involved in decision making regarding how they spend their day. Examination of a selection of care plans indicates the home is now placing a higher importance on planning and implementing activities for residents. Each resident has an activities sheet, which the staff team must complete and make comments regarding if the resident appeared to enjoy the activity. The care plans provide the staff team with detailed information about what activities residents enjoy and also provide detailed risk assessments regarding all activities undertaken in the community. The risk assessments have been produced to support residents to overcome difficulties and engage in activities in a safe manner. The inspector spoke to member of the staff team who made the following comments: “ Since L’s involvement in the home and the arrival of the home manager residents’ are getting out more and we are looking into all sorts of activities we think residents might like to try.” During the visits to the home the inspector spoke to a relative of a resident who said she was always made to feel welcome and was given good information about how her relative was. The inspector spent approximately two thirds of the inspection visit with residents and observed members of the staff team supporting residents in a supportive, respectful and warm manner. Residents’ are provided with a varied diet with specialist diets and requirements being recorded in residents care plans and risk assessments. The inspector observed members of the staff team supporting residents to eat their lunch. Residents’ care plans indicate significant relationships in their lives and clearly indicate the responsibility of the home to support residents to maintain them. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. Residents’ personal care needs are met by the home in an individualised sensitive and supportive manner. The home meets the physical and emotional health needs of residents well. The home’s medication policies and procedures safeguard residents’ health and wellbeing. EVIDENCE: The care plans and risk assessments provide the staff team with detailed information about the most appropriate and safe way to support residents with their personal care needs. This guidance involves practical help for the staff team regarding how clients like their hair washed, how to use lifting and moving equipment to cause the least distress and anxiety to residents. All contact and input by health care professionals are recorded in a designated section of the care plan. With home visits be documented and signed by the visiting professionals. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 15 The home manages all five residents medication needs including ordering, storing and administering. All members of the staff team who administer medication have received training from the visiting pharmacist. The home has clear policies and procedures regarding the administration of residents’ medication including where required risk assessments detailing how to administer specific medication. A selection of residents’ medications and corresponding medication administration record (MAR) sheets were examined and were well maintained. Residents’ care plans and risk assessments provide the staff team with good information about environments or situations that bring residents enjoy or distress. Enabling the staff team to support residents appropriately and safely. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The staff and management at The Maples deal with issues of concern in a sensitive and professional manner. The home’s practices and commitment to staff training protect residents for abuse, neglect and self-harm. EVIDENCE: Residents receive information about how to complain and raise concerns about the service they are receiving in the Statement of Purpose and the Service User Guide. The service manager is developing a pictorial and easy read version of the complaints procedure for residents’. This allows residents to understand their rights to raise issues of concern and to have their opinion heard. The inspector spoke to a relative during the visit who told the inspector they felt comfortable talking to the manager or members of the team if they were concerned or unhappy about their relatives care. They discussed an issue of concern with the inspector and asked the inspector to raise it with the manager. This issue was discussed and the service manager and the home manager who were awaiting information from health care professionals and would then address the relative’s concerns in full. As part of the organisations induction process all staff attend protection of vulnerable adults training with refresher training being provided on an annual The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 17 basis. The home manager is providing the staff team with a discussion and awareness session next week regarding issues of diversity and equality for residents. The level of detail held in residents care plans and risk assessments enable the staff team to support residents’ appropriately and limit the potential for the development of poor or neglectful practice. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,29 & 30 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The Maples provides a safe, comfortable and homely environment for residents to live in. EVIDENCE: Since the last inspection visit the lounge and dining room have been decorated and refurbished providing attractive and comfortable areas for the residents to use. The home has purchased specialist seating for one resident, which is more comfortable and versatile than the current chair. The home manager told the inspector all five bedrooms were being redecorated in the next few months with the first two commencing on the 3/7/06. The inspector viewed a number of bedrooms, they had been personalised to reflect the hobbies and styles liked by residents. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 19 The home has a range of specialist equipment and adaptations for use by residents and is proactive with regard to accessing specialist services to support residents to maintain their independence and safety. The house and rear garden are well maintained and provide residents with a clean homely environment in which to live. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34, 35 & 36 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The recent changes in the management team have had a positive impact on staff moral and confidence resulting in a more proactive, supportive and enabling environment for residents to live in. EVIDENCE: Since the last inspection visit the service manager has implemented changes to the recording and storage of information with regard to staff employment and training records. Having designated areas for the storage of recruitment information, supervision, training and attendance records. These changes have made the information held much clearer and uniformed allowing the home manager to identify training needs much easier. Since the last visit to the home the staff team have undertaken the following training: safe moving and handling, understanding challenging behaviour (British Institute of Learning Disabilities accredited) and fire safety training. Just over 50 of the staff team have gained NVQ level 2 in care. The manager provides the staff team with formal supervision bi-monthly and informal supervision on a daily basis. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 21 The service manager is currently visiting the home on a weekly basis and offers the house manager formal supervision on a monthly basis and support and guidance on each visit. Members of the staff made the following comments: “ Since L and M have been involved with the home I understand more about my role and how important the information I have is to support the residents properly”. “ L and M are very clear about how they want us to work and are very supportive and helpful if there are any problems”. Since L and M have been at the home I feel more confident in my job”. The service manager and the home manager told the inspector the following training has been arranged for the next three months: epilepsy awareness, basic food hygiene and equality and diversity training. The home currently has four fulltime support worker post vacancies, which are being covered by the home’s existing staff, bank staff and agency. CIC have a set list of staffing agencies that are used to provide cover in their services’. When the home is using agency staff the rota indicates their full names and the agency they are employed by. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,42 & 43 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The home is well managed with all functions of the home being resident focused and looking to outcomes for individuals. The home’s policies, procedures and practices protect and promote residents best interests and the staff teams health and safety. EVIDENCE: Since the last inspection visit a service manager and house manager have been transferred to the home resulting in major improvements in the quality, accuracy and detail of the information held regarding residents’ health and emotional wellbeing. CIC intend to make an application to the Commission to register the home manager in respect of The Maples. An application must be received by the Commission, within seven days of receipt of this report. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 23 The staff team appear to be more focused and confident in their roles and more aware of the outcomes for residents’ receiving their care and support. The accident/ incident records were examined and indicated appropriate information and actions had been taken. The fire safety logbook was examined and records indicate appropriate checks and training are taking place at the required intervals. All electrical appliances were tested and assessed as safe in April 06. The utilities were tested last August 2005 and are due to be tested for their safety this year. The inspector viewed a number of financial procedure and practices. Such as for those staff with responsibility of holding and spending money on behalf of residents a list of their name and sample signatures are held in the office. This provides an audit trail for the manager and provides a safeguard for residents’ against incidents of financial abuse. The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 3 X 3 3 The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 Requirement The registered persons must ensure the residents’ contracts accurately reflect the legal responsibilities of both parties regarding the purchase and maintenance of the home’s minibus. Previous timescales of 12/01/06 & 20/6/05 not met. The registered persons must ensure residents’ or their representatives are involved in the decision-making regarding entering into “Hire Agreements” for the use of the Home’s minibus. This involvement must be documented and made available for examination by the Commission. The registered persons must ensure work continues to take place to support and facilitate residents to access a variety of age and culturally appropriate activities on a regular basis. Timescale for action 30/08/06 2. YA7 12 30/08/06 3. YA12 16 30/10/06 The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 26 4. YA37 8 The registered persons must ensure a completed application form to register a manager is received by the Commission within the stated timescale. 30/07/06 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 Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Maples DS0000018946.V291519.R01.S.doc Version 5.1 Page 28 - 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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