Inspection on 10/10/06 for The Thorns

This inspection was carried out on 10th October 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Thorns 14/10/08

The Thorns 13/01/06

The Thorns 19/08/05

The Thorns 27/01/05

The Thorns 22/06/04

The Thorns 29/08/02

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Thorns Coastal Road Hest Bank Lancaster Lancashire LA2 6DW Lead Inspector Mr Ajam Auckburally Unannounced Inspection 10th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Thorns Address Coastal Road Hest Bank Lancaster Lancashire LA2 6DW 01524 822558 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) Morpress Properties Mrs Denise Audrey Shuttleworth Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th January 2006 Brief Description of the Service: The Thorns is situated in Hest Bank village in Lancaster and close to the Lancaster canal. The home provides accommodation for a maximum of fifteen residents of both sexes who are 65 and over. Accommodation is provided in 11 singles and 2 double bedrooms. The double rooms are mostly used as singles, unless they are occupied by married couples who want to share a room. All the bedrooms, except two have an ensuite facility. The bedrooms are well furnished but service users can furnish their rooms with their own furniture if they wish. The home is situated away from the main road and although local shops and amenities are close by, they are not easily accessible by frail elderly people. The home is staffed around the clock and residents said that they are well cared for. There were thirteen residents residing at the home at the time of the inspection. They all said that they are well cared for and that all the staff are kind and considerate. Current weekly fees are between £450 and £525 and additional extras like hairdressing, private chiropody and newspapers are paid for by the residents. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Under IBL (Inspecting for Better Lives) The Thorns was assessed as requiring a statutory key visit (inspection) between April 2006 and March 2007. An unannounced key site visit was carried out on 10th October 2006 which lasted for 5.5 hours. The inspection was carried out against the National Minimum Standards for Older People. The inspection despite being an unannounced one was carried out in a friendly atmosphere and with the full cooperation of the staff and the residents. During the inspection, some records were looked at and all the residents and the staff were spoken to. The residents were very positive about the care they receive and the way the staff treat them. Evidence about the inspection was gathered firstly by sending out a questionnaire for the manager of the home to complete and return. The completed questionnaire gave information about several areas such as staffing, checks that the home has made about the safety and maintenance of the building, information about residents and other useful information. Questionnaires were also sent to residents, the families and the staff. Six residents and four relatives returned their completed forms. When they were analysed, they showed that everybody was happy with the quality of care provided and the facilities at the home. One relative commented that she would like to see a member of the management team on duty at weekends. The manager has taken this on board. During the inspection, case files of residents were looked at to check that records of needs and action taken were recorded and reviewed. Residents and staff were spoken to and their comments noted. There were 13 residents living at the home at the time of the inspection and there were the manager, 3 care staff, 1 of who was doing the cooking (the cook was off) on duty. The number of staff on duty was sufficient to look after the residents. The staff were observed to be polite and attentive when talking and dealing with the residents. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Several areas of the home have been decorated and refurnished. The dining room has had new curtains fitted. The percentage of care staff with NVQ 2 and above has increased to 81 . Transport to hospital and other appointments are provided free to the residents. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures and practices to admit new residents are good. Prospective residents are given adequate written and verbal information to make an informed choice about the home. EVIDENCE: The manager said that new residents or their families are given every opportunity to visit The Thorns and spend as much time as they want when looking for a home. She said that verbal and written information is given at this stage. The file of the last person admitted was examined and it showed that a pre admission assessment was carried out. The assessment showed that several The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 10 areas of needs were identified and that the staff at the home were able to meet them. The areas include mobility, personal hygiene, social needs etc. The manager said that part of the assessment is to ensure that staff can deliver a full service to the residents. She also said that residents’ cultural and individual needs are assessed to ensure that any special needs are met. The last resident admitted said that she came to have a look at the home with her family. They all liked what they saw and were impressed with the friendliness of everybody and the cleanliness of the home. Written information about the home such as the service user guide is given to prospective residents/or their families. The manager said that no residents are admitted to the home unless an assessment has been carried out to ensure that the person’s full needs can be met. She said that where possible a member of the senior staff would visit prospective residents either in their own homes or in hospital. Intermediate care is not provided at the home. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment and care provided to residents are good. The residents’ needs are fully met. EVIDENCE: Two residents were case tracked to discover how the staff care for them and whether the services they receive meet their expectations. This means that two residents were selected by the inspector and the care they receive examined closely. Their assessments and care plans were examined and they were spoken to. One of the residents being case tracked was the last one to be admitted. The resident said that her family and herself had no hesiation in choosing the home. She said that everybody was so friendly and explained everything clearly The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 12 The other resident was able to express an opinion and said that she is well looked after and that the staff are very good. The records of the two residents were examined and they showed that full assessments were carried out and that the care plans identified needs and how they were being met. The rest of the residents said that they like living at the home and that the staff are kind. They said that they can do what they want and that the staff would assist them when required. The staff said that they are involved in the care plans of residents by delivering services and writing notes in the daily diary sheets. They said they care for all the residents with respect and dignity. They also said that they treat everyone as an individual and accept that people are different and have different needs. They were observed being polite, patient and caring when dealing with the residents. All the residents are white British, but the manager said that if a resident who is not white and British was to be admitted to the home, she will make sure to have as much information as possible by doing some research in order to meet their care, their cultural and dietary needs. Resident’s health care needs are met by involving health care professionals. GP’s, District nurse and chiropodist visit when required. Four survey cards were received back from relatives. They were positive about all aspects of care and staffing. One relative commented that neither the manager nor the deputy work at weekends. The manager said that although she and the deputy are not rostered to work weekends, they are often on duty to cover during annual leave and sickness. The manager said that she will be considering working some weekends as a matter of course. The medications records were examined and they were found to be accurate. The inspector observed the senior staff dispensing medications in accordance with good practice. Medications are only dispensed by senior staff who have had training on medications.. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements to meet the social and recreational needs of the residents EVIDENCE: When the inspector arrived to start the inspection at 10 am, only two residents were up and about. They were sat in the porch having a chat. The rest of the residents were in their rooms after having had their breakfast there. They said that they like to relax by watching television or reading their newspapers after breakfast. They said that there is no pressure by staff for them to go downstairs. Some residents came down about 10.30 for morning coffee and others had theirs in their rooms. The staff said that the residents are free to what they like and spend their day as they wish. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 14 The inspector spoke to all but two residents when they came in the lounge. They said that they are very happy living at the Thorns and that everyone is nice and caring. They said that they can do what they like and do not have to join in activities if they do not want to. One resident who stays in her room for most of the time said that she enjoyed the privacy of her room and that the staff are very kind and care for her very well. She said that she gets regular visits from other residents who keep informed as to what’s going on. The resident said that nothing is too much trouble for the staff. They come and have a chat and make sure that I am all right. Activities in the home include Tai Chi, Bingo, board games, entertainers etc. The residents said that there is enough to do if you like to join in communal activities. Several of them said they like to do their own things and join the activities they like. They said that no one is forced to do anything. Most of the residents went on a boat trip on the canal recently. They said that they enjoyed it very much and are looking forward to the next one in the summer. The staff said that they try and meet residents’ individual needs. They said that if residents wanted to go for a walk or do something, they would try to oblige. The residents said that the food is very good and that they are offered plenty to eat and drink. A choice of food is not provided at lunchtime when the main meal of the day is served. However, the manager said that if a resident does not like something, a substantial alternative is provided. She said that all the staff are aware of the likes and dislikes of the residents. On the day of the inspection, the main meal for lunch was Meat and Potato Pie which all the residents had. They all said that they enjoyed it very much. Meals are served in the dining room which is well furnished and decorated. Residents may eat in the lounge or in their rooms if they prefer. There is a good choice of food to choose from at breakfast and teatime. A cooked breakfast is available for those who want it. Records of meal served examined show that a good variety of meals are offered to the residents. The manager said that within reasons, the home The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 15 could cater for every taste. She said that food to suit ethnic and cultural preferences would be offered to residents if required. Residents are offered hot drinks at regular intervals during the day. They said that they find that the regular drink rounds are adequate for their needs, but would ask the staff for a drink if they wanted one at other times. Fresh fruit is provided to residents either in their rooms or the lounge. The manager said that within reasons, residents can have what they want to eat. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. There are detailed policies and procedures to safeguard residents from abuse. Residents live in a safe environment. EVIDENCE: The manager has produced policies and procedures for dealing with complaints and abuse. The complaint procedure is included in the Service User Guide. It is available to residents and their families. Written information about how and who to complain to is given to residents or their families. The manager was advised to record any complaints and concerns she may receive in a book and also to record the outcome of any investigations. The residents said that if they had any complaints, they would speak to the manager and have every confidence that their concerns would be dealt with. The manager said that the management team is always available to speak to the residents or their families. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 17 There are systems in place for staff to report any incident of abuse either by staff themselves or by families. All the residents appeared to be safe and free from harm, neglect and abuse. Staff were observed treating the residents with respect and dignity. The staff spoken to were aware of different types of abuse. One member of staff spoken to was able to describe abuse as being physical, emotional and financial. Several staff have attended a course on abuse awareness. Residents said that they are well looked after and that all the staff are kind and helpful. There were no visible signs of abuse or neglect. The staff spoken to said that that they would not harm the residents in any way and care for them with respect and dignity. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area good This judgement has been made using available evidence including a visit to this service. The home provides a well-maintained and safe environment for the residents to live in. EVIDENCE: During a tour of the building, the home was found to be clean and in good hygienic order. Some residents were in their rooms and they said that they like to stay in their rooms to read or watch television. The bedrooms vary in sizes, but are of good proportions. All except two have an ensuite facility. The two bedrooms without ensuite, share a bathroom. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 19 There is a large lounge and a dining room which the residents can use freely. The home is well maintained and the colours are light and pleasant. Some of the central heating radiators have been fitted with low heat surface covers. The remaining ones must be done by the end of March 2007. The cleaning of the home is done by the care staff. They said that they have enough time to do this task, as there is always an adequate number of staff on duty. The home has a well-maintained garden at the front with a pond. Ducks from the canal nearby visit the pond and are fed by the residents and staff. There is a long drive leading to the road and shops. However, this is not suitable for frail elderly people to use. A couple of residents can use it with the aid of staff to go to the shops. There is car park at the rear of the home. The residents’ general comments were that the home is beautiful, clean and homely. The home has made great effort in providing aids and adaptations to help residents with physical disabilities. Handrails have been fitted alongside the corridors to help residents with mobility. There are grab rails fitted to some of the toilets to help residents who are disabled. A passenger lift and is available for the residents to use independently if they wish. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are good arrangements for staffing the home well. Residents are cared for by a team of caring staff. EVIDENCE: The number of staff on duty has been maintained to a good level to meet the needs of the residents. At the time of the inspection, there were 2 care staff, 1 manager, 1 senior carer who was doing the cooking in the absence of the cook on duty. Staff rotas checked showed that the staffing level is maintained to a good level ensuring that there is always an adequate number of staff on duty. The staff files examined show that appropriate checks had been carried out before offers of employment had been made. Such checks included CRB (Criminal Records Bureau) checks and a POVA (Protection Of Vulnerable Adults) check. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 21 Training records show that the staff at The Thorns have attended several courses. These include: Abuse, Moving and Handling, First Aid, Medications, etc. The written recruitment policy gives detail of the way a member of staff is employed. When there is a vacancy for a job, it is advertised locally and interested parties are given application forms to complete. From information received, prospective staff are selected for interviews. Once a new staff has been selected, two written references are taken and POVA (Protection Of Vulnerable Adults) and CRB (Criminal Records Bureau) checks are done. No staff starts work until satisfactory checks have been done. Once a new member of staff starts work at the home, she undertakes an induction-training programme involving orientation of the home, meeting residents and staff. Training also include, Fire Procedures, Moving and Handling and many other relevant courses. Staff spoken to said that they treat all the residents with respect and accept any difference people may have. CSCI (Commission for Social Care Inspection) recommends that at least 50 of care staff achieved NVQ (National Vocational Qualification) level 2. The percentage of care staff at The Thorns with this qualification is 81 and is commendable. The staff spoken to said that they enjoy working at the home very much. They said that the management is very supportive and listens to what they have to say. The residents said that the staff are marvellous and will do anything for them. There were good interactions between the residents and the staff. They all appeared to be happy and content The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good management team at the home. The residents and staff benefit from living and working in a well managed home. EVIDENCE: The Thorns is owned by the Bates family under the name of Morpress Properties. The registered manager is Denise Shuttlewoth and she has worked at the home for several years. She is supported by a deputy and other staff. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 23 The inspector found that the home is being well managed and that the residents are well looked after. Residents and or their families are encouraged to deal with their own finances. Most of the fees due to the home are paid for by direct debit arrangements. Where the home, keeps money on behalf of residents, appropriate records are kept. One of the owners visits the home on a regular basis to talk to the manager, staff and residents. He has been advised to complete a Regulation 26 form. This form is completed to ensure that owners who do not work at the home on a daily basis either himself or herself or a representative looks at all areas of the home and leaves a written report. A copy of the report is also sent to CSCI. The staff said that the owner is approachable and that they can talk to him when they want. The home has a written health and safety policy in place which is supported by a number of associated procedures such as COSHH (Control Of Substances Hazardous to Health) and infection control. The home was awarded the IPP (Investors in People) in 2003. Investors in People is the national standard which sets out a level of good practice for the training and development of people in order to achieve business goals. The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 25 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 2 Standard OP37 OP25 Regulation 26 23 Requirement Timescale for action 30/11/06 The owner must complete a Regulation 26 form about his findings when he visits the home All central heating radiators must 31/03/07 be fitted with low heat surface covers (previous date 30/6/06) 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 Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Thorns DS0000009876.V307792.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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