Inspection on 02/02/06 for Thomas House Care Home

This inspection was carried out on 2nd February 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Thomas House Care Home 24/07/07

Thomas House Care Home 29/06/06

Thomas House Care Home 28/09/05

Thomas House Care Home 28/07/04

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 Thomas House 168 Prescot Road West Park St Helens Merseyside WA10 3TS Lead Inspector Mrs Trish Thomas/Lorraine Farrar Unannounced Inspection 2nd February 2006 12:30 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 Thomas House DS0000022411.V283623.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 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. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Thomas House Address 168 Prescot Road West Park St Helens Merseyside WA10 3TS 01744 608800 01744 670701 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) Thomas House (St Helens) Limited Mrs Barbara Thornber Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users to Include up to 28 (OP) Date of last inspection 29/09/05 Brief Description of the Service: Thomas House is a privately run care home located in St Helens, Merseyside, close to local shops and transport links. St Helens town centre is approximately one mile away. The home has 24 single rooms with en-suites and 2 double rooms. It is registered for 28 elderly persons and is a no smoking home. The home is within a large house built in the 1870’s and has had extensive renovation work done to extend the facilities. Thomas house opened as a care home in 1997. Accommodation is on two floors and has a selection of communal areas, including a library, lounges, dining room, and treatment room and hairdressing salon. Toilets and bathroom facilities are located throughout the home. There are extensive gardens surrounding the home and a small patio area at the rear. Ample car parking space is situated at the front of the home. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a four-hour period and methods used were, discussion with eight residents, five members of staff and the manager, reading care/medication and staffing records and touring the premises. What the service does well: What has improved since the last inspection? The manager now has access all information regarding the day-to-day running of the home, which ensures she can manage the service effectively. Training records, staffing and maintenance information were easily accessed during the inspection. Staff have received training in Protection of Vulnerable Adults since the last inspection. The home was free of offensive odours and maintained to a good standard of hygiene. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 6 What they could do better: In order to ensure that residents are protected by the home’s policies and procedures for dealing with medication, the following requirements and recommendations are made. The manager must provide storage for controlled drugs, that is in line with legislation and introduce a stock checking system for medication. All supplies of prescribed dressings must be labelled and used for the resident it is prescribed for, or returned to the pharmacy. The manager should provide written guidelines for medication prescribed as “when required” or “as directed” There was a delay in answering a resident’s call for assistance although some staff were aware that this person needed help. One member of staff ignored a colleague’s request to assist this resident, another appeared rushed and disappeared to get protective gloves and an apron. The resident was left standing in the bathroom doorway looking lost and calling for staff. The manager must instruct staff of the requirement to maintain residents’ privacy and dignity at all times, by prioritising their responses and attending the most urgent requests for assistance without delay. The majority of residents were receiving the care and attention which they needed. There are two requirements, which relate to health & safety with regards to protecting residents against the risks of fire/smoke inhalation and scalds. The manager must instruct staff that fire doors must not be wedged open and ensure that this instruction is followed. The manager must arrange for hazard signs to be placed over wash hand basins to warn of very hot water. In order to ensure that the information in care files is accurate and that information is easily accessible, two recommendations are made. The manager should instruct staff to complete details of medical interventions/professional visits in residents’ individual medical records. The manager should audit care plans to remove all duplicated information. To protect against the risk of cross infection, the manager must instruct staff not to store clean towels on open shelves in the laundry area and ensure that the instruction is followed. Please contact the provider for advice of actions taken in response to this Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 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 Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The home has detailed assessments and care plans in place for residents, which identify their support needs. Residents’ healthcare needs are identified and met by the home. Staff who work in the home receive training in managing residents’ prescribed medication and storage facilities are provided. Shortfalls were noted regarding stock checking, returns, storage facilities for controlled drugs, and “as required” medication. Residents are well cared for and, in general, their privacy and dignity was being respected. In one instance, staff failed to prioritise the care needs of a resident. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 11 EVIDENCE: Care plans were read for four residents. Care files contained a review sheet, signed by the member of staff, to confirm each monthly review of the care plan. Care plans had been signed by the resident agreeing to the contents. Good practice was noted in that care plans contained in depth personal profiles, which listed the person’s preferences. For example, one plan stated that the resident likes to have support to phone their family, and enjoys a small glass of whisky occasionally. Two members of staff spoken with were also able to provide this information and explain how they support the resident with these choices. Plans give detailed information regarding the support the person needs with their personal care and health-care, and listed the health professionals who attend the person. Up to date assessments were in place for personal care, social interaction, manual handling, falls, medication, mental health and medication. Plans are also in place to support the person with their nutrition and records of the persons weight are maintained. Personal details included the resident’s religious beliefs and there were arrangements in place for visiting religious ministers to attend the home every two weeks. Residents looked well cared for and appeared relaxed and at ease. A visitor to the home, who was spoken with. She said that she calls in to the home several times a week, “I am very satisfied with all aspects of care for my mother.” A resident who commented said, “I get all I need, I have no complaints. It was evident through discussion with staff that they have a good working relationship with local health professionals, who visit the home to meet residents’ healthcare needs. In addition to that provided by the home, staff have access to training via the local Primary Care Trust and work in partnership with district nurses who visit the home. Care plans contain very clear information about the person’s preferences, and up to date plans and assessments. The care files are unwieldy, and it is difficult to access information quickly. This could lead to staff not being able to find the information necessary to support a resident effectively. Both the manager and homeowner said that they are aware of the excess information held in care files, and are in discussions to review the care-planning content. There is a medical sheet on each care file, where staff record interventions such as GP visits and paramedical treatment. In the sample, which was read, these reports were out of date. Medical interventions which had been referred to in daily reports, had not been completed on the medical sheets, these omissions give an inaccurate account of the levels of support provided in the home. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 12 Nominated staff who manage residents’ prescribed medication, have received related training. A member of staff spoken with explained she had received inhouse training and also completed a distance-learning course on medication. Medication is stored in a locked room. There were some controlled drugs on the premises, locked in a cupboard, which did not meet regulations. It is a requirement of this report that the home provides suitable storage for controlled drugs. Other medication was stored correctly and the medication area was clean and well maintained. There was no clear audit trail for medication held by the home, for example on 16th January 56 tablets were received for one resident, these were signed as administered, over a period of seventeen days, but there remained fifty-six tablets in the container. The member of staff spoken with was unsure as to why this had occurred, however the manager later explained that there were tablets remaining from the previous delivery. Another resident had been prescribed paracetamol, for “as required”. This medication had last been received into the home in August 05. There was no clear audit trail stating the quantity administered and the quantity in stock. The manager must implement a clear stock check system for medication to ensure that stocks are audited and accounted for. The home had a small supply of medication that was no longer in use, this included, Fucidin cream, which had been opened, dated 19/9/05, and shampoo dated 27/4/05. An audit system would also ensure supplies of prescribed medications no longer in use are not retained in the home. One resident was prescribed GTN spray, as required, the member of staff spoken with said that carers know what this is for, and when to administer it. The manager should provide written guidelines for medication prescribed “as required” or “ as directed” which should include what the medication is for and the signs and symptoms it is given for. This will help to ensure residents are offered the correct treatment as required. Records and amounts of controlled medications held were checked and were all up to date and in order. The home has a room allocated for the storage of dressings, many of which are used by the visiting district nurses. This room contained supplies of unboxed dressings and a box of dressings dated 23/9/03 from which the label had been removed. The manager must arrange for these to be returned to the pharmacy and ensure that no medications, including prescribed dressings, are held in the home unless they are prescribed and labelled with the person’s name, and used only for that person. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 13 There are two double bedrooms in the home, with screening provided. The remainder of bedrooms are for single occupancy. Residents looked well cared for and staff were respectful towards them. An incident was observed where staff failed to prioritise a resident’s need for attention, leading to lack of recognition for his/her privacy and dignity. The inspector remained with the resident and requested that a member of staff attended to this request for assistance. The incident was discussed with the manager during the inspection. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15 Social activities are provided in accordance with the needs and preferences of the residents. There is good community contact with families, voluntary groups and health professionals. The home provides varied meals and snacks in pleasant surroundings and residents are satisfied with the quality of meals provided. EVIDENCE: Residents’ preferences regarding social activities are recorded on their care plans. On one resident’s daily routine file it was recorded, “Does not join in activities.” This lady confirmed that she prefers not to get involved in group activities. “I like to read and have a chat, I’m not one for joining in.” The manager said that residents go out to visit their families, some had been out for Christmas dinner. The manager said that religious ministers visit the home and residents are supported to attend local churches if they wish. There is an activities calendar, where events are recorded. Keep fit sessions provided by a voluntary organisation, were said to be well attended and enjoyed. The home does not have an activities co-ordinator and members of care staff are nominated each day, to supervise activities. An entertainer had been planned Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 15 for the coming Valentines Day. A visitor said that she or her sister, visit the home daily and are always made welcome by staff, and given privacy to chat with their mother. Newspapers and magazines are set out on a table outside the lounge for residents, and there are televisions in bedrooms and the lounges. Quality Assurance records and comments/compliments were read. A relative wrote “Thank you. Thomas House is a special place.” On the day of the inspection the home had provided a Chinese themed meal for residents. The dining room had been nicely decorated with Chinese lanterns and drawings and the menu displayed. Alternatives were provided for people in accordance with preference. A resident said, “The food is good here and we get cups of tea between meals.” The home provides a separate dining room with well-presented tables and décor. A carer explained that the home employs a cook who works 7-2 pm and provides a main meal at lunchtime with a designated carer to provide a lighter meal in the evening. On the day of the inspection this consisted of, potato cakes, beans and bacon or sandwiches and a choice of two puddings. The Carer explained that residents are asked each afternoon what they want for their evening meal and a resident said, “The food is lovely”. The kitchen area was clean with plenty of supplies of food including fruit and vegetables. Kitchen records of temperatures are well maintained and records of menus kept. Good practice was noted in that bowls of fruit are available in lounge areas and supplies of hot drinks were regularly available. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home has clear adult protection polices in place and provides training for staff in the prevention and detection of abuse. EVIDENCE: Staff spoken with had received training in adult protection and records showed that the majority of staff had attended this training in December 05 / January 06. In addition the owner explained that some staff had recently attended a course run by Age Concern. Copies of the Local Authority Adult Protection procedures are available within the home. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The home is clean and hygienically maintained with protective clothing provided for staff. Areas of possible cross infection have been identified by the manager and preventative action planned. EVIDENCE: On the day of the inspection the home was clean, hygienically maintained and free from odours. There is a separate laundry room, which has two dryers and two industrial washing machines with sluice facilities. A member of staff was able to explain the systems used for dealing with used linen and the home has supplies of disposable gloves and aprons. Stocks of clean towels are kept on open shelves in the laundry area. It is recommended that these are stored elsewhere to prevent any possible cross-infection. Carers working in the kitchen area wear disposable aprons, however these are located within the kitchen and do not completely cover the carers’ uniforms. This was discussed with the manager and owner who explained they had Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 18 already identified a possible risk of infection and were able to explain the action they planned to rectify this. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29, 30 The home has over 50 of staff holding an NVQ care qualification. The home has a satisfactory recruitment procedure and satisfactory vetting of staff was being carried out. Staff’s training needs are identified through annual appraisals, and training is arranged in accordance with residents’ needs and mandatory requirements. EVIDENCE: Eleven care assistants hold a care qualification (NVQ), at level 2 or above and six are currently working towards obtaining this qualification at level 2 or 3. A Senior member of staff spoken with said that she held a care qualification and had received training recently in, fire, emergency aid, adult protection, continence care and pressure area care and had training booked for moving and handling people. A recently appointed member of staff explained she was working towards her care qualification and had received training in continence care and fire safety with moving and handling booked. A sample of staff files, which were read, contained the information, which is in accordance with Schedule 2, Care Home Regulations, including two references, evidence of CRB clearance and proof of identity. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 20 Training records in the home provided evidence that training has been provided for staff in emergency aid, food hygiene and COSHH (Control of substances hazardous to health), with training booked for dementia care and fire. These records demonstrated that all basic training requirements had been identified, and where this was outstanding the training had been booked. The Owner explained that the home works closely with the local Primary Care Trust and a local college and accesses both distance learning courses and short courses. The manager said that staff have recently attended courses on dementia and palliative care. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,36,38 The manager is qualified and fit to be in charge of the care home. There are systems in place to protect residents from financial abuse/exploitation. Staff are appropriately supervised through one-to-one meetings with senior staff. Shortfalls were noted regarding risks from hot water and fire safety. EVIDENCE: The manager said that she has four years management experience and holds a management qualification (NVQ4). A member of staff said there is an open door policy and the manager is available and very approachable. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 22 The manager confirmed that the home does not become involved in residents’ financial affairs. Residents have access to independent advocacy services and contact details are displayed in the home. The manager said that staff received formal supervision six times a year and an annual appraisal. On a tour of the building, it was observed that the lounge door was held open with a wooden wedge. This is a fire door and must be kept closed or be fitted with an automatic closer. In one bedroom, which was visited, the hot water from the outlet in the wash hand basin, was extremely hot to touch. In all such instances, a hazard sign must be place prominently over the wash hand basin. Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 23 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The manager must provide storage for controlled drugs, which is in line with legislation. (Recommendation from last inspection, requirement now given). The manager must introduce a stock checking system for medication. The manager must ensure that all supplies of prescribed dressings are labelled and prescribed for each individual resident. The manager must instruct staff of the requirement to maintain residents’ privacy and dignity at all times, through providing support without delay, in response to their requests/agitation. The manager must instruct staff that fire doors must not be wedged open and ensure that this instruction is followed. The manager must arrange for hazard signs to be placed over wash hand basins to warn of DS0000022411.V283623.R01.S.doc Timescale for action 02/05/06 2. 3. OP9 OP9 13(2) 13(2) 02/04/06 03/02/06 4. OP10 12(4) 03/02/06 5. OP38 23(4) 03/02/06 6. OP38 13(4) 02/04/06 Thomas House Version 5.1 Page 25 very hot water. (Outstanding from last inspection extended time limit given). 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 2 Refer to Standard OP7 OP7 Good Practice Recommendations The manager should instruct staff to complete details of medical interventions/professional visits in residents’ individual medical records. The manager should audit care plans to remove all duplicated information. (Repeated recommendation from last inspection). The manager should provide written guidelines for medication prescribed as “when required” or “as directed” The manager must instruct staff not to store clean towels on open shelves in the laundry area and ensure that the instruction is followed. 3 4 OP9 OP26 Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Thomas House DS0000022411.V283623.R01.S.doc Version 5.1 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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