Inspection on 11/05/05 for The Trees

This inspection was carried out on 11th May 2005.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Trees 28/10/08

The Trees 10/11/06

The Trees 12/12/05

The Trees 20/12/04

The Trees 24/06/04

The Trees 23/03/04

Similar services:

Hillside

Applegarth

Trevayler Residential Care Home

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

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

CARE HOME ADULTS 18-65 The Trees Deveron Way Hinckley Leicestershire LE10 0XS Lead Inspector Rajshree Mistry Unannounced 11 May 2005 at 11.00am 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 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 Stationary 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 Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Trees Address Deveron Way Hinckley Leicestershire LE10 0XS 01455 615523 01455 614317 None Leicestershire County Council Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Karen Maxted Care Home 23 Category(ies) of PD Physical Disability - 9 registration, with number MD Mental Disorder - 8 of places SI Sensory Impairment - 4 LD(E) Learning Disability over 65 - 1 Learning Disabiity - 23 The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No one person within category mental disorder may be admitted into the home where there are 8 persons of category mental disorder already accommodated within the home. No one person within category mental disorder may be admitted into the home unless that person falls within category learning disability i.e. dual disability. No one person within category physical disability may be admitted into the home where there are 9 persons of category physical disability already accommodated within the home. No one person within category physical disability may be admitted into the home unless that person falls within category learning disability i.e. dual disability. No one person within category sensory impairment may be admitted into the home where there are 4 persons of category sensory impairment already accommodated within the home. No one person within category sensory impairment may be admitted into the home unless that person falls within the category learning disability i.e. dual disability. Date of last inspection 20th December 2004 The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 5 Brief Description of the Service: The Trees is a purpose built home for people with learning disabilties, situated in a residential area of Hinckley. The home is a provision of the Leicestershire County Council. The Trees is located close to a public bus route and train station. The town centre is approximately 1 mile from the home. There are shops and other local amenities close to the home. The home provides care on a short and long term basis for twenty-three adult residents in the categories of learning disabilities, mental disorder, physical disorder and sensory impariment. The home has five separate units within the main building, some of these being adapted to provide services for residents complex needs. The accommodation for most residents is in single bedrooms, some with en-suite facilities. There are a number of lounges throughout the home. Bathing, shower and toilet facilities are spread throughout the home. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place from mid-morning on 11th May 2005 for 5 hours. The Assistant Manager was present at the start for the morning shift followed by another Assistant Manager for the afternoon shift. A tour of the units took place and some records within each unit were examined. Two service users were spoken with and one service user was observed specifically look at their lifestyle at the home and how their care needs were met. Individual plans of care and records were examined. Key workers for two service users talked about care provisions, how the identified needs were met and training undertaken. The information received in the completed pre-inspection questionnaire was used as a resource about the current status of the home. Eleven comment cards were received from relatives/main carers and four comment cards were received from service users. All were very positive and complimentary about the care provided by the home for the service users. What the service does well: The home provides a relaxed atmosphere and people are welcomed by a friendly team of staff. There is lots of information about activities and events available to service users and visitors to the home. Each unit is individual in décor, which creates a warm and comfortable atmosphere. Service users views and opinions are central to the way in which the home is managed. The home has an open door policy whereby service users can approach the Registered Manager, the Assistant Manager and carers at any time to discuss any topic. There is a focus on service users having the freedom to continue living independently. Meals are prepared in each unit for service users who receive a choice of nutritious and balanced menu. Service users have a stimulating and varied lifestyle. Medication procedures are good and well managed. Service users have an assessment of need carried out by health and/or social care professionals prior to admission to the home, and have an opportunity to visit the home meeting service users and staff. Staff were observed providing assistance and engaging with service users using appropriate forms of communication. The Trees accesses a variety of specialist care professionals who support the service users. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 7 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 Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 9 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 standard(s) 2, 4, 5 The admission process is well managed and service users are given clear and detailed information regarding the service. The robust assessment process ensures that care needs are met. There is a flexible and individual approach for service users to test drive the home. EVIDENCE: There is a good admission procedure which includes the assessments of individuals are carried out by the health and/or social care professionals, as part of the referral process. Four service user files were viewed. They detailed the specific care needs of service users, identifying the needs that would be met by heath and/or social care professionals. The contractual agreement for a service user on a short-stay was viewed and this detailed the terms of the short-stay. This is an internal local authority document that is known as “the individual placement agreement”. Service user was aware of his contract to stay at the home. A resident who regularly has short-stays at the home stated that he had originally visited the home before choosing to stay at the home. Staff that spoke to the Inspecting Officer described the procedure for receiving new service users, which is flexible, tailored to the individual service users need, encouraging a visit during the day, with or without service users, staying for a meal or participating in an activity, having an opportunity to speak with other service users and staff. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 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 standard(s) 6, 7, 10 There has been a significant improvement and development of person centred plans for service users. Service users’ choices and decisions have a direct impact on the care they receive and their preferred daily lives. Service user information is secure and treated with confidence. EVIDENCE: There has been improvement in the development of person centred plans for service user. Staff have completed training in the development of person centred plans (PCP). Three permanent service users’ and one short-stay service user’s PCP were examined and found to be holistic reflecting the service users needs, evidence of consultation and their goals and aspirations identified. The PCP were easy to follow by staff supported by the risk assessments, which covered health and safety issues. The PCP detailed other professionals and key people involved with the service user ranging from the social worker, consultant, family members, staff at the college or the day centres and the key worker. Each unit maintains a working PCP and up to date daily records. One service user that spoke to the Inspecting Officer described the short-term goals currently and those already achieved. The individual plan examined The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 11 contained the agreed goals, evidence of service users’ making decisions about their lives. The service user was aware of information about him being treated confidentially and his right to access his records. Daily records examined reflected the monitoring and progress towards achieving the identified personal goals. Discussion with staff in the short-stay unit indicated that although there are regular service users for short-stay they do not all have an individual PCP. It was recommended that as good practice service users regularly having short-stays at the home could benefit from having a PCP that is reviewed for each stay, where appropriate. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 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 standard(s) 11, 12, 13, 14, 15, 16, 17 Service users have a stimulating and varied lifestyle at the home that is individually tailored and flexible. Social organised excursions are provided through consultation with the service users. Service users are supported to access the local community and social events. There is a good choice of meals and mealtimes are flexible to meet the lifestyle of the individual within the home. EVIDENCE: On arriving at the inspection, one service user was seen watering the plants outside the home. Further discussion with the service user confirmed that he enjoys helping around the home in the mornings and attend the local day centres every afternoon. The service user stated that there is a contract that has been agreed with him to meet his specific needs, which was viewed with explanation provided by the service user. The individual plans included personal goals. Another service returned home from spending a day out at Market Bosworth with her key worker. The Inspecting Officer observed the non-verbal communication between the service user and the key worker, using gestures, touch and laminated pictures placed on hooks on the wall. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 13 Educational, social and leisure activities are individually developed for each service user and in consultation with key activities and people involved. On the day of the inspection visit, the Inspecting Officer was told of 5 service users being away on holiday for five days with 3 staff. Service users are informed of the opportunity to go on holiday and provided with information, leaflets and brochures about the holiday options. Service users are able to access all the communal areas within the agreed rules of the home, i.e. service users need to knock and wait to be invited in. Service user’s visitors are welcome at any time although can be determined by the service user. Events hosted at the home where family and friends are welcome to attend are displayed on the notice boards in each unit and at the main entrance. There is the Charter of Residents Rights and rules of the home. The Charter of Rights is shared with each service user at the point of admission in the appropriate mode of communication such as written spoken, using pictures, symbols and sign language. Service users are encouraged to share issues, concerns or suggestions directly with the staff or through the advocate that visits regularly. During a discussion with one service user the Handy Person was observed asking permission from the service user, to do deliver a new suite to the home. Each unit has its’ own kitchen and menus that are developed by the service user. The menu for the week in one unit was viewed. There is a good choice of breakfast, lunch and evening meals appropriate to the younger adults and nutritionally balanced. During the tour of the premises, each unit had a bowl of fresh fruit on the dining table. Staff spoken with said that where service users have an interest in the preparation of meals, they are encouraged to help. The meal times are flexible. Drinks and snacks are available throughout the day. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 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 standard(s) 20, 21 Staff in consultation with service users on short-stay manage medication. Management of medication is good. Service users’ receive their medication timely and is accurately recorded. Policies and procedures are in place and up to date. EVIDENCE: One service user on a respite stay discussed with the Inspecting Officer the medication he was on and was clearly aware of its purpose. The service user showed the Inspecting Officer the medication timetable displayed for the unit and was clearly aware of the member of staff who had the responsibility of administering the medication. The medication storage and administration was viewed in one unit for three service users. The medication and medication record was found to be in good order. The management of controlled drugs was in good order with signatures of two staff confirming medication had been administered. Evidence and audit of ordering, receipt and return of medication were up to date. The policy on ageing, illness and death has been reviewed and re-worded since the last inspection. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 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 standard(s) 22 Service users can express their views. Any concerns are dealt with, before the situation affects the service users’ wellbeing and results in a complaint. EVIDENCE: The home’s complaints procedure is displayed on the notice board around the home. The complaints procedure is available in other formats such as pictorial. Service users spoken with were aware of whom to contact and speak with should they have any concerns. The Commission for Social Care Inspection has not received any complaints since the last Inspection. The Inspecting Officer was unable to view the record of complaints’ as this was not accessible to the Assistant Manager. Comment cards received from service users and relatives were positive with regards to how complaints were responded to. One comment card stated, “we did have concerns . . . . . ., but we felt our complaints were dealt with appropriately . . .”. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 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 standard(s) 24, 25, 27, 30 A comfortable and safe standard of accommodation is provided for the residents including the garden area, which individually and collectively meets the resident’s needs. EVIDENCE: Each individual unit is named, with the primary function of either long stay or short stays. The home in general is well maintained and suited to the needs of service users. It is decorated and furnished to a standard that creates a comfortable and homely environment. Service users can be involved in the maintenance of the home. For example, one service user is responsible for watering the plants on the grounds of the home, which is incorporated into the individual plan of care and daily living. A service user spoken with said he likes the idea of the new sitting room and new furniture in the home. Three bedrooms of service users were viewed, and found to be comfortable and clean. Service users were asked as to their view of their individual bedrooms and the communal areas; all expressed a satisfaction with the accommodation provided. Since the last inspection there has been a new kitchen, bath/shower rooms and new furniture installed in several units. On The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 17 the day of the inspection, new three-piece suite was delivered for the shortstay unit. Comments received from service users included: • “My bedroom is very comfortable”. • “I like to help around the home”. The home provides sufficient lavatories and bathing/shower facilities to meet the needs of service users. The home provides for individuals accessing the short respite stay unit with appropriate bathroom and shower facilities. Service users have access to equipment such as hoists to assist them and staff in the delivery of personal care. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 35,36 There is a robust staff training programme in place to ensure staff are well trained and supervised to carry out their work safely and competently. Staff are supported and access specialist training to focus on meeting the needs of the service users. Domestic staff appointed have clear duties and responsibilities. EVIDENCE: The home operates a key working system whereby each service user has at least two named key workers to meet their needs and provide support for daily living. Service users spoken with confirmed they have a key worker who responds to their needs in a timely manner. The Inspecting Officer examined two Carers and one Assistant Manager’s training records and certificates. The training demonstrated that staff receive a range of training skills and knowledge including moving and handling, SPIC, communication training, challenging behaviour, safe administration of medication, risk assessing, developing person centred plans (PCP) and confirmation of completed National Vocational Qualification levels. Key workers for new service users moving to the home are identified using the staff training/skills matrix and the needs of the service users. There is flexibility to change key workers, when required. Staff employed at the home undertakes a 12-week induction programme within a probationary period that incorporates principles of Learning Disability Accredited Framework (LDAF). Staff that spoke with the Inspecting Officer The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 19 confirmed that they are encouraged to identify their training needs, which would result in improving the care provided at the home. A member of staff expressed an interest in learning Makaton or a similar signing skill that would improve the communication with service users. Since the last inspection domestic staff have been appointed to allow carers to focus on service users. Staffing at present is supplemented by the use of agency and casual staff with the regulated checks, training and supervision, although interviews are being conducted to recruit a further four part-time staff. All staff receive one-to-one supervision on a regular basis, attend staff team meetings and receive an annual appraisal, which is recorded. Comment cards received from service users and relatives were very positive and included: • • • “staff are always helpful and involved in her overall care plan and day care” “ . . . he is always greeted with a smile and a friendly hello”. “ . . . really looks forward to his respite stays at the Trees. It is a fantastic place, made that way by the brilliant staff” The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 41, 42 Service users are consulted about living in the home. Records are secure and treated in confidence. Environmental improvements have resulted in service users and staffs’ health, safety and welfare being promoted and protected. EVIDENCE: There are regular Residents’ Meetings with the support of an advocate. Information is shared with service users and any views, concerns and suggestion are raised with the home’s Manager. The observed interaction between staff and service users was relaxed, friendly, using a soft tone of voice that indicated reassurance. Communication observed included speech, using signs, gestures and symbols with face-to-face contact. Service users reviews are on going, with formal review meeting scheduled for either every 6 months or 12 months. Service users spoken with were aware of the records held at the home and securely stored in accordance with data protection. Examination of three service users care records showed service users were involved and consulted The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 21 about their provision of care. In general the records were secure, available and up to date. The records of complaints received was not accessible or available for inspection, refer to the section on Complaints, Concerns and Protection, page 15. Since the last inspection there has been a significant improvement of the environment to ensure that health and safety of the service users. For example new shower/bathroom suites installed, new kitchen, new furniture, including pedal bins to remove the risk of spread of infection and external decoration has commenced. The major work identified has been referred to the Property Officer and a list is maintained which is monitored. The Handy Person at the home undertakes weekly health and safety checks of the premises, water temperatures and deals with minor faults and repairs. The health and safety records examined were up to date. During the tour of the premises fire exits were clearly marked and were not obstructed. Fire drill records and safety equipment were tested and up to date. Work is in progress to improve the fire risk assessment following the Fire Officer’s Inspection recently. Additional health and safety checks are delegated responsibilities of senior staff supported by the programme of maintenance. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Trees Score x x 3 3 Standard No 37 38 39 40 41 42 43 Score x x 3 x 3 3 x C51 S35333 The Trees V224892 110505.doc Version 1.30 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 22 Regulation YA22(8) Requirement The Registered Manager shall make available the summary of the complaints received for inspection. Timescale for action By 11th June 2005 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 that service users accessing short-stay visits have a person centred plan developed, which can be reviewed at each stay. The Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 24 Commission for Social Care Inspection The Pavilions, 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX 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 Trees C51 S35333 The Trees V224892 110505.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!