Inspection on 31/01/06 for The Progress Project

This inspection was carried out on 31st January 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Progress Project 26/05/09

The Progress Project 15/09/08

The Progress Project 26/02/08

The Progress Project 06/09/06

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOME ADULTS 18-65 The Progress Project 22 Winchester Road Worthing West Sussex BN11 4DH Lead Inspector Mr D Bannier Unannounced Inspection 31st January 2006 09:30 The Progress Project DS0000064669.V281738.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 Progress Project DS0000064669.V281738.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 Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Progress Project Address 22 Winchester Road Worthing West Sussex BN11 4DH 01903 233390 01903 233390 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) Hemmingrod Ltd trading as The Progress Project Mr Kenneth Brady Care Home 7 Category(ies) of Past or present alcohol dependence (7), Past or registration, with number present drug dependence (7), Mental disorder, of places excluding learning disability or dementia (7), Mental Disorder, excluding learning disability or dementia - over 65 years of age (2) The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A total of seven (7) service users in the category MD may be accommodated of whom up to seven (7) service users may be in the categories drug dependence past/present, alcohol dependence past/present. Service users in the category MD(E) are aged between 65 and 70 years. N/A 2. Date of last inspection Brief Description of the Service: The Progess Project is a care home registered to provide accommodation and personal care for up to seven residents with mental illnesses between the ages of 18 to 70 years. Within this number residents with past or present alcohol and drug dependency may also be accommodated. The home is a detached property situated in a residential area of Worthing. Local shops and other amenities are within walking distance. Communal facilites currently include a lounge and dining room which are located on the ground floor . Private accomodation consists of seven single bedrooms. The service is privately owned by Hemmingrod Ltd, who have identified Mr Belisario Schiavone as the responsible individual to supervise the management of the care home. The registered manager is Mr Kenny Brady who is responsible for the day to day running of the Progress Project. The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection since the Progress Project was registered in September 2005. It was an unannounced inspection, started at 9.30am and lasted seven and a half hours. The inspector spoke to three of the five residents who were living there. The inspector also spoke to the deputy manager and three staff who were on duty. The deputy manager showed the inspector around the communal areas of the home. Some records were also seen. The inspector looked at how residents are assessed before they are admitted; how residents’ emotional and health care needs have been met; the recruitment of staff and the training provided; and how the care home has been managed. The deputy manager and the staff on duty were very helpful and assisted the inspector with his assessment of the service. What the service does well: The Progress Project has been set up to provide care and support to people with complex mental health needs and challenging behaviours who have become isolated and socially excluded. Residents may also have secondary problems related to alcohol and drug abuse. It is the aim of the Progress Project to provide a therapeutic environment where residents can be rehabilitated. It is expected that, after a period of time, residents will move on to more independent living in the community or into another care home. Whilst it is still too early to tell what the care home does well, the inspection identified clear evidence that confirmed the manager and his staff have established a sound base from which the aims of the Progress Project can be realised. Residents told the inspector that they felt safe and well supported by the manager and his staff team. The Progress Project DS0000064669.V281738.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 Progress Project DS0000064669.V281738.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 Progress Project DS0000064669.V281738.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): 2 The registered person has developed a comprehensive means of assessing each resident’s needs before they are admitted. EVIDENCE: Care records of two residents were looked at. The assessment process has been designed in three parts. Part one consists of a referral form that the prospective resident is asked to complete. It asks the resident to provide information regarding their psychological, emotional, social, physical and spiritual needs. Part two consist of a referral form for the referring professional, such as the resident’s social worker to complete. The information asked includes a pen picture of the resident, family background, interests and hobbies and a brief medical history. Part three is a risk assessment checklist. This seeks to identify any possible risk in terms of violent tendencies by the resident to themselves or to others, any risk of self-neglect or any vulnerability to abuse by others. The forms include a written referral procedure. The procedure includes informal visits to The Progress Project, a formal interview with the manager and a member of staff, discussion between the team as to whether the resident’s needs can be met and, finally setting a date for the resident to move in. As there was no record, it has been recommended that the decision process is documented and kept on the resident’s file. This will provide information regarding what was discussed and how the decision was made. This The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 9 information should then be used to write to the prospective resident to confirm in writing if the Progress Project is suitable to meet their needs. The Progress Project DS0000064669.V281738.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 and 9 The manager was able to demonstrate that residents know about their individual care plans. It was clear that residents are helped to make decisions about their own lives and are supported in taking risks. EVIDENCE: Residents have a care plan that identifies how their assessed needs will be met by the staff at the Progress Project. This is called a personal progress plan and identifies each resident’s assessed needs and personal goals. It also includes information with regard to the activities that each resident will be involved in to meet them. Activities include household chores, individual sessions with an identified member of staff, known as a key worker, and activities based in the community to promote social inclusion. The programme also identifies free time where residents can choose what they wish to do. The inspector advised the manager to ensure the home’s care plans are reviewed to ensure they include clear instructions or directions to staff with The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 11 regard to how residents’ needs are to be met. This is to ensure consistency and continuity of care, which is essential for residents who have complex needs. For example, records included phrases such as that staff should “support” a resident. The manager was advised that care plans should include information to staff about how each individual should be supported, including frequency and the level of support required. Residents also have a care plan, drawn up by their Community Psychiatric Nurse (CPN), which identifies other agencies involved with the individual resident. Other agencies that are involved in this way include their CPN, their social worker and their consultant psychiatrist. The care plan provides each resident with information about the role of each person and what they can expect from them to ensure identified needs and goals are met. Underpinning residents’ care plans are risk assessments that have identified the level of risk involved for each resident and the level of support each resident needs to make and carry out decisions about their individual lifestyle. Residents told the inspector they felt safe and well supported. The staff are helpful and understood what they needed in order to fulfil their chosen lifestyle. One resident said that he was hoping to move out into his own flat once he felt confident to do so. The Progress Project DS0000064669.V281738.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): No standards in this section were assessed on this occasion. EVIDENCE: The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 13 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 and 20 Some work is needed to ensure staff have been given clear directions with regard to providing support to residents in a the way they prefer and require. Appropriate steps have been taken to ensure residents’ physical and emotional health care needs have been met. Some work is needed to ensure medication is administered to residents safely. EVIDENCE: Residents have a care plan that identifies how their assessed needs will be met by the staff at the Progress Project. This is called a personal progress plan and identifies each resident’s assessed needs including any physical and health care needs, and personal goals. The inspector advised the manager to ensure the home’s care plans are reviewed to ensure they include clear instructions or directions to staff with regard to how residents’ needs are to be met. This is to ensure consistency and continuity of care, which is essential for residents who have complex needs. For example, records included phrases such as that staff should “support” a resident. The manager was advised that care plans should include information to staff about how each individual should be supported, including frequency and the level of support required. The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 14 Underpinning residents’ care plans are risk assessments that have identified the level of risk involved for each resident and the level of support each resident needs to make and carry out decisions about their individual lifestyle. This includes assessing if the resident has a history of refusing to take prescribed medication. At present no residents are considered capable of self administering prescribed medication. Current practices for the administration are considered unsafe. Medicines are usually administered at mealtimes. The member of staff administers the medication whilst in the office, where medicines are stored. The medication is then taken to the resident in a plastic pot. This means there is a risk of the resident being given the wrong medication, as there is no means of checking the directions before the resident is given the medication. The manager is advised to review procedures and practices to ensure the medicines are administered to residents from containers marked with the name of the medication, the time it is due to be taken, the dosage and the name of the resident for whom the medicine has been prescribed. The manager was advised to review practices and rewrite procedures to ensure they are in line with current guidance issued by the Royal Pharmaceutical Society. As current practices are potentially dangerous a requirement has been made where the manager must make the necessary changes in practices within an agreed time frame. The manager will be expected to provide the Commission with a written action plan to confirm what will be done to improve practices. The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 15 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): No standards in this section were assessed on this occasion. EVIDENCE: The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 16 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): No standards in this section were assessed on this occasion. EVIDENCE: The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 17 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): 32, 34 and 35 The manager has ensured competent and qualified staff support residents. Improvements need to be made to the care home’s recruitment practices to ensure residents are protected from possible abuse. Whilst residents’ needs are being met by appropriately trained staff, some minor improvements have been identified to ensure all staff are trained in accordance with National Minimum Standards. EVIDENCE: A minimum of two project workers is on duty between 7am and 9pm each day. A manager and two assistant managers, who have qualifications and experience relevant to the needs of residents accommodated, support them. The management team take it in turns to work over weekends so that one or other of them is available to provide support as required. At night, between 9pm and 7am, one project worker is one duty and awake. A member of the management team who is on an on call rota supports this person. The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 18 The Progress Project has been registered since September 2005. Since that date there has been a large turnover of staff. This is not unusual for a care home as it establishes itself during the first year of operation. Three new members of staff have been appointed since January 2006. Due to insufficient numbers of staff available to cover the rota, the manager took the decision to appoint them before appropriate criminal record checks (CRB) had been returned. Applications for such checks have already been submitted and should be returned in the coming weeks. Following discussion, the manager was advised that staff should not work in the home until CRB checks have been returned. This is to ensure vulnerable residents are protected from abuse. In the meantime, staff without CRB checks must by supervised by another suitably experienced member of staff for whom a check has been obtained. In addition, they must not escort a resident outside the care home unless accompanied by another member of staff who has a CRB check. The member of staff should also sign a self -declaration stating that they do not have a criminal record that would put at risk vulnerable adults. The inspector spoke to three staff that were on duty. They spoke about the induction process that they had been through. The process has been designed by the Progress Project and introduces new staff to the residents accommodated. It also deals with familiarising themselves with the procedures of the home, including fire procedures, and the mission statement of the Progress Project. This process is usually completed within the first few weeks of appointment. The inspector looked at the records of two of three staff that were appointed during January 2006. As there was no documented evidence of the induction process, the manager was advised that a record of induction should be kept which includes the components of the induction and evidence that the new member of staff had demonstrated their competency in each area. Following discussion, the manager was advised to research the induction programme, which has been devised, by Skills for Care, the Sector Skills Council for Social Care. This will ensure new staff will complete an induction programme, which complies with the National Minimum Standards for Care Homes for Adults. This programme should be completed within the first six weeks of appointment and covers the principles of good care practices. In addition the manager was also advised to research foundation training, which has also been devised by Skills for Care. New staff should complete this within the first six months of employment. The programme provides staff with the necessary skills and understanding to enable them to provide support to residents in accordance with their individual care plans. The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 19 The Skills for Care Induction and Foundation training also prepares staff to undertake the National Vocational Qualification (NVQ) at Level 2 and 3 if they choose to do so. This means that all staff employed at the Progress Project will be trained in accordance with the national minimum standards. One member of staff informed the inspector that they are currently working towards obtaining the NVQ award at Level 3. This person is also due to start a three-day course entitled “Understanding Psychosis” in the near future. Another member of staff informed the inspector that they are researching training courses for themselves. The manager said that individual training needs are identified as part the supervision process. All staff receive individual supervision and support with a manager every fortnight. The Progress Project DS0000064669.V281738.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 and 42 Appropriate steps have been taken to ensure the home is being well run. The manager has been able to demonstrate that residents are consulted with regard to the monitoring, review and development of the home. The manager needs to take appropriate action to ensure that, in the event of fire, it is contained. The manager also needs to take appropriate action to ensure residents are not at risk of cross infection. EVIDENCE: The registered manager if The Progress Project is Mr Kenny Brady. However, due to recent staff changes within the group of homes registered with the provider, Mr Brady has recently started a three month secondment to manage a sister care home. The Commission has been told that, during this period, the deputy manager will manage the Progress Project. The registered provider has confirmed that the deputy manager has the necessary skills and experience to fulfil this. Although this arrangement only started the day before this The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 21 inspection took place, it does not appear to have affected how the Progress Project is being run. Records seen showed that registered provider has arranged to have the care home visited on a monthly basis by a representative in order to monitor the care and services provided. It was clear that, during such visits, the representative speaks to residents in order to find out their views with regard to how the home is being run. The inspector saw a poster advertising a residents meeting which is held every Wednesday. The poster encouraged residents to attend to provide them with a chance to air their views and to offer suggestions with regard to where improvements can be made. Residents told the inspector that their views are listened to. From direct observation, staff do spend time talking with residents and listening to their views and ideas. It has become the practice for the doors to the front office, the lounge and the dining room to be wedged open. It was explained that this is demonstrate to residents that they are welcome to come into the office unless it is clear a meeting is taking place. However, these doors are clearly marked as being fire doors, and must be kept shut at all times. The manager was advised to consult with the local fire prevention officer to find out how such doors may be kept open without compromising the safety of residents and staff. The inspector noted that a resident had left their clean washing on top of the machine in the laundry. The manager told the inspector that each resident is given a time when the laundry is available to them to wash their clothes. Further discussion revealed that is the practice for residents to carry their laundry through the kitchen to the laundry without using a basket or any other container. The inspector reminded the manager that this was not satisfactory as other residents and staff may be at risk of cross infection. The manager was advised to consult with the local environmental health officer to find out how dirty washing may be transported through the kitchen without compromising the safety of residents and staff. The Progress Project DS0000064669.V281738.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 3 3 x 4 x 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x 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 x 13 x 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 x 2 x 3 x 3 x x x 2 The Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 23 NO 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 YA18 Regulation 15(1) Requirement Timescale for action 06/03/06 2 YA20 13(2) 3 YA24 23(4)(c) (i) 4 YA30 16(2)(j) Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, amend care plans to include information to staff with regard to how service user’s needs in respect of their health and welfare are to be met. The registered person 06/03/06 shall make arrangements for the safe administration of medicines received into the care home. The registered person 06/03/06 shall after consultation with the fire authority make adequate arrangements for containing fires. The registered person 06/03/06 shall having regard to the size of the care home and the numbers and needs of service users after consultation with DS0000064669.V281738.R01.S.doc Version 5.1 Page 24 The Progress Project 5 YA34 6 YA41 the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. 19(1)(b) The registered person 06/03/06 shall not employ a person to work at the care home unless subject to paragraphs (6), (8) and (9), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. 17(2)Schedule4.6(g) The registered person 06/05/06 shall maintain in the care home the records specified in Schedule 4; in particular a record of all persons employed at the care home, including in respect of each person employed a record of all training undertaken including induction training. 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 Progress Project DS0000064669.V281738.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Progress Project DS0000064669.V281738.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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