Inspection on 09/05/06 for The Old Vicarage [Cannington]

This inspection was carried out on 9th 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Vicarage [Cannington] 08/12/05

The Old Vicarage [Cannington] 12/07/05

The Old Vicarage [Cannington] 24/11/04

The Old Vicarage [Cannington] 23/06/04

The Old Vicarage [Cannington] 06/05/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Old Vicarage The Old Vicarage Brook Lane Cannington Bridgwater Somerset TA5 2HP Lead Inspector Judith Roper Key Unannounced Inspection 9th May 2006 09:45 The Old Vicarage DS0000031640.V292703.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 Old Vicarage DS0000031640.V292703.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 Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address 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) The Old Vicarage Brook Lane Cannington Bridgwater Somerset TA5 2HP 01278 653688 Somerset County Council (LD Services) Mrs Deborah Winter Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The bedroom that is below 10 square metres can only be occupied by fully mobile residents. Registered for a total of eight persons with a Learning Disability. Seven of these persons may also have a Physical Disability. 8th December 2005 Date of last inspection Brief Description of the Service: The Old Vicarage is a large two storey building situated in the centre of the village of Cannington. The house is adjacent to the church and is close to a village pub. The home is within walking distance of the local amenities. The town of Bridgwater is five miles away. The Old Vicarage is a home run by Somerset Social Services Community Directorate. The registered manager is Mrs. Deborah Winter. The responsible individual for the service is Mr. David Dick. The Old Vicarage is registered with the Commission for Social Care Inspection to provide care for eight people with learning disabilities and physical disabilities. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day between the hours of 09.45 am – 1pm. Eight residents were at the home on the day of the inspection. There are currently no vacancies at the home and there have been no admissions since the previous inspection, or indeed for a few years. The inspector was able to see and observe staff interactions with all eight residents. No relatives were visiting the home at the time of the inspection. The registered manager Mrs Winter was not scheduled on duty on the day of the unannounced inspection and the inspection was therefore led by the home’s senior staff member on duty, Mrs. Harris. The inspector would like to thank the duty staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and informal. Staff carried out their duties in a friendly and professional manner. This focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The inspector has found that on this visit the overall quality of the service is good. Records examined during the inspection were four service user care and support plans, medication administration records and maintenance records. On request the home completed a pre-inspection questionnaire and monthly quality auditing visits to the home by the network manager were forwarded for two months prior to the inspection, on request. Minutes of the last staff meeting were also supplied to the inspector. The total time spent in planning the inspection, carrying out the visit and consolidation of evidence and report writing has been 12 hours. At The Old Vicarage residents all have impairment with speech and language skills. Residents communicate using other verbal sounds than words such as gesturing, pictures/drawings or Somerset Total Communication signs/symbols. The staff at the home know the residents very well as the staff team is settled and the residents have lived at the home together for a number of years. As at the previous announced inspection in December 2005 this inspection has found that the home is providing sensitive individualised care for its residents. What the service does well: Staff know the needs of residents well and residents are relaxed and content. Individualised person centred care is given. The building is maintained well The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 6 and accommodation in bedrooms provides a very high standard of personalised space. 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 Old Vicarage DS0000031640.V292703.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 Old Vicarage DS0000031640.V292703.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): Non applicable. EVIDENCE: There have been no admissions to the home for some time. There are no vacancies at the home. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 9 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, 10. The overall outcome for these assessed Standards is good. Care and support plans are good reflecting current care needs. Care and support plans are regularly reviewed. This enables staff to deliver care that meets needs. Residents are risk assessed for daily activities and safety action plans are in place. Resident’s are being given more opportunities at the home to participate with the day-to-day domestic management of the home. This is to give residents a sense of achievement and self-esteem. Information around the home for residents takes the form of written English, pictures and Somerset Total Communication symbols. This enables residents to understand the daily routines at the home. The staff team know resident’s needs well and are able to care for residents in a way that provides individualised care. Confidentiality is maintained although attention needs to be given to unsecured care records kept in the home’s lounge. EVIDENCE: Four resident care plans were inspected in detail. The information in the plans is detailed and reflects person centred planning. Plans are critically reviewed The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 10 monthly. Residents are unable to participate fully in their care planning process due to their complex disabilities. The Old Vicarage is currently piloting a change in care and support plan documentation to provide a summary of resident current care needs in a shorter ‘my day’ document form in addition to the full care and support plan. In this way it is hoped that relief staff will be able to refer to a synopsis of resident care needs in an easy to read shortened document. Some care and support plans indicate that fluid intake needs to be monitored for some service users. Care staff record this but there is no rationale for fluid monitoring or a guide to the minimum daily amount that an individual should be aiming to consume daily. This information is recommended. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 11 Care plans include clinical and environmental risk assessments. The home utilised lap straps for some wheelchair users to prevent falls from the wheelchairs and baby monitors for listening to service users at night vulnerable to nocturnal epilepsy. It is recommended that the service users who need restricting in wheelchairs for safety purposes or to be subject to nocturnal listening surveillance consent to this or if unable that their next-of-kin/care managers be consulted and this recorded. The registered manager continues to work with her staff team to increase the amount of choice and participation for residents in their daily life and daily routines, such as bed making, food preparation, laundry skills and kitchen tidying. Daily working documents of care records are stored unsecured in the lounge. Other records are stored securely in the manager’s locked office. The Old Vicarage DS0000031640.V292703.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. The overall outcome for these assessed Standards is good. Residents are being encouraged to actively participate in the home’s daily domestic routines. This is good as it promotes structure and purpose to the day. Residents access the wider local community for leisure and shopping and the amount of opportunities for this is good with sufficient staffing levels in order to facilitate this. Staff support resident’s emotional and social needs with a professional kindness. This contributes to the air of calmness in the home. Meal times are unhurried and personal attention is given to residents by staff. EVIDENCE: Residents are being supported to manage their bedroom personal space according to ability. Since the reduction in access to day care services last year to residential home clients the residents had been spending more time at the home. The home addressed this by providing an increased staffing complement during the day to enable residents to attend leisure opportunities in the surrounding community. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 13 Employment or educational opportunities are limited for the residents due to their physical, emotional or learning disabilities. The home is next to the village church. One resident choose to be a member of the local church congregation. Residents are given the opportunity to access the local and wider community as the home has suitable adapted disabled transport. Outside trips or 1:1 time for leisure is recorded in the service user’s ‘my day’ plans. Activities take place in the home on a daily basis and residents have part of their contract several ‘quality days’ per year or a short annual holiday, based on individual ability and preference. This is being achieved. Staff on duty were interacting with residents in a friendly and sensitive manner. Residents approached staff for social interaction on a 1:1 basis and staff gave this attention. Residents were free to move around the home in order to find alternative points of interest or to be alone. The gardens are pleasing and accessible but residents need supervision in the gardens. Meals are provided in the dining room. Most residents require supervision or assistance at meal times. The daily menu is flexible to choice. Meals are cooked on the premises. The kitchen is suitably equipped. Fridge/freezer temperatures are recorded daily and cold stored food in use is labelled with use by date. There is a written cleaning schedule for the kitchen for staff to follow. There are good supplied of fresh fruit and vegetables at the home and this is offered daily. Where service users need specialised adapted diets or assistance at mealtimes, information on how to assist the individual is written in their care and support plan. The Old Vicarage DS0000031640.V292703.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. The overall outcome for these assessed Standards is good. Personal support for residents is individual and sensitive to needs ensuring good care and health support for service users. Additional medication training for staff has been ongoing for staff since this was recommended last year. Management of medicines is adequate, but attention is recommended for some record keeping and cold medicine storage management. EVIDENCE: All residents at the home need personal care support. Several residents need two staff to assist with these tasks. Suitable equipment is available in the home to assist staff with this. Community health care professionals are involved in the overall care management of residents on a continuing basis. Specialist community health care professionals also consult on health care matters for individual residents. Records of professional visits/advice are entered into personal care and support plans. Care plans reflected that health needs were anticipated and acted upon. Health issues that were not anticipated were also managed appropriately and effectively. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 15 No resident in the home is able to manage his or her own medication. Staff administer medication. Medication records for the month were examined and the records were managed generally well. As per the last inspection visit, hand transcribed entries were not always signed by two staff and variable dose recording was spasmodic. It is recommended that MAR charts be audited regularly to identify poor practice in record keeping and appropriate action instigated. The home has a system of asking staff to sign to say that they have read the home’s policies and procedures in the administration of medicine and two staff supervise one another in medication administration. Storage of cold medicines was examined. The home has a fridge dedicated for storing medicines. The home does not have a ma/min thermometer or record of recording the temperature of the fridge, this is recommended. There was one item stored in the fridge at the time of the inspection. This item did not need to be stored in a cold place and was removed by staff during the inspection. The Old Vicarage DS0000031640.V292703.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. The overall outcome for these assessed Standards is good. There is an open atmosphere in the home for the raising of concerns and there have been no complaints received at the home since the last inspection. Residents are risk assessed for self-harm or neglect. Staff are aware of the signs of abuse and of how to report suspected abuse. Resident’s monies are audited fortnightly to detect any concerns for financial abuse. This is good practice. Staff received an abuse training update in the last year. EVIDENCE: The home has a complaints procedure. It is not displayed prominently in the home, as there is risk of this being taken or destroyed by residents. Polices and procedures are available in the home for the protection of vulnerable adults. The policy is the multi-agency protocol for Somerset in the Protection of Vulnerable Adults. There has been a staff training update in the protection of vulnerable adults in the last year, as recommended by the inspector. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 17 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, 26, 27, 28, 29, 30. The overall outcome for these assessed Standards is good. The Old Vicarage is a character property providing good spacious living areas for residents. Bedrooms are personalised and attractive, decorated to an excellent standard. The home is clean and well equipped for the physical needs of residents. There has been new laundry equipment, additional moving and handling equipment and new carpets to hallways, corridors and stairs in the last year. The home would benefit from some routine redecoration on the ground floor communal areas and corridors. EVIDENCE: The physical premises were inspected. Communal areas are spacious and accessible for residents. The home was clean to a good domestic standard on the day of the inspection. The carpets for the ground and first floor hallways and stairs have been replaced in the last year. There is some wear and tear to communal ground floor areas and ground floor corridors. Residents have single bedrooms. They are spacious meeting resident physical needs, are personalised very attractively and have equipment installed to meet handling needs of individuals. Sensory equipment is also provided in bedrooms. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 18 Bathrooms are sufficient to meet resident needs. One shower room has recently been upgraded and the large disability equipped bathroom has been decorated pleasingly in the last year to make a more homely space. Residents are also able to listed to music of their choice whilst bathing as a sound system speakers have been wired into the bathroom (a safe distance from wet areas). Access to the laundry is not convenient for wheelchair users but residents can assist with folding their laundry if it is taken to the lounges. The two communal lounges are showing some signs of wear and tear in places such as damage to paint work from wheelchair users but the communal spaces are utilised very well and provide sufficient space for residents to socialise. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 19 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): 34, 35. The overall outcome for these assessed Standards is poor. There is good investment in staff training. This means that residents receive care from skilled staff. Volunteers must be subject to satisfactory Criminal Records Bureau checks before escorting residents out of the home in order to protect service users. EVIDENCE: There a few staff vacancies and very few vacant shifts that need to be covered. If this is so, the shifts are covered in-house or occasionally by relief workers. The home is now works with a minimum of four staff during the mornings, which provides appropriate staffing support for the physical and emotional dependency levels of residents. At night there is one waking staff member and one sleeping-in night staff member on duty. There have been no new staff employed since the last inspection. There is a volunteer worker who has been associated with the home for several years. This person needs to have a CRB check and has been outstanding for some time. This is poor practice in the protection vulnerable adults. Staff training records were provided with the pre-inspection questionnaire. This year there has been suitable staff training provided at The Old Vicarage, including support for staff to obtain NVQ awards in care. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 20 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, 39, 42. The overall outcome for these assessed Standards is good. The standard of the home management is good and resident safety is risk assessed and managed on an individualised basis. Quality assurance processes are both formal and informal. Somerset Social Services Community Directorate runs the service. Somerset County Council was recently awarded a maximum three stars in its annual inspection. EVIDENCE: Health and safety equipment servicing information was supplied in the preinspection questionnaire. This was cross-checked against servicing labels on equipment in the home. A network manager for social service completes a monthly health and safety/quality assurance check (Regulation 26 reports). Copies of two months recent reports have been forwarded to the CSCI on request. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 21 The home notifies the CSCI of reportable significant events in the home via the Regulation 37 reporting process. The service is run by the County Council Social Services, who provide their own insurance for The Old Vicarage. The home uses both Council generic and service specific policies and procedures. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 22 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 X 2 N/A 3 X 4 N/A 5 X 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 4 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 23 N/A 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 YA34 Regulation 19 (5) (d) (ii) Requirement It is required that all staff, including volunteers, have been satisfactorily vetted by POVA/CRB prior to accompanying service users on trips/outside social events. Timescale for action 08/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations It is recommended where service users have their fluid intake monitored to ensure sufficient daily intake, that a guideline for the minimum daily intake for the service user be stated in the care and support plan to assist staff in the care management of the individual. It is recommended that where surveillance listening devices are used in the home for safety management of service users and where wheelchair lap straps are indicated for restrictive safety purposes, that this is stated in the care and support plan with a record of the individual’s consent or evidence of consultation with nextof-kin/care manager. It is recommended that a max/min thermometer be DS0000031640.V292703.R01.S.doc Version 5.1 Page 24 2 YA9 3 YA20 The Old Vicarage 4 YA20 purchased for the monitoring of the temperature of the medicines fridge to ensure this is between 2 to 8 degrees Celsius. It is recommended that MAR records be audited regularly to ensure that hand transcribed entries have two staff signatures and that variable dose recording is consistently entered. The Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Old Vicarage DS0000031640.V292703.R01.S.doc Version 5.1 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. 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