Inspection on 23/08/05 for Thorley House

This inspection was carried out on 23rd August 2005.

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

The inspector 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

Thorley House 29/01/09

Thorley House 05/12/06

Thorley House 05/12/05

Thorley House 22/12/04

Thorley House 02/06/04

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 Thorley House Hazelmere Gardens Hindley Wigan WN2 3QD Lead Inspector Lindsey Withers Unannounced 23 August 2005 rd 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 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. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Thorley House Address Hazelmere Gardens, Hindley, Wigan, WN2 3QD. 01942 255370 01942 525054 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) CLS Care Services Limited Mrs Rhona Briggs Care Home Only 40 Category(ies) of Old Age 40, Physical Disability Elderly 8 & registration, with number Dementia Elderly 1 of places Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include:up to 40 service users in the category of OP (Older People over 65 years of age) to include: 8 service users in the category of PD(E) (Physical Disability over 65 years of age). 1 female service user in the category of DE(E) Dementia over 65 years of age. 2. One named service user (TM) may be accommodated in the category of DE(E) 3. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 22nd December 2004 Brief Description of the Service: Thorley House is a property that was built in the 1950s specifically to provide residential care for the elderly. The home has capacity for 40 residents and is situated between large council housing estates and privately owned properties. It is served by a good bus route and is close to local shops. Parking is available for visitors. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over 5.5 hours on one day, and was unannounced. Part of the time was spent in the office looking at the paperwork that the home needs to keep the run the business. A tour of the building took place, with assistance from the maintenance man. The Inspector interviewed three members of staff, and had good conversations with four residents. Other residents and staff were briefly spoken to during the course of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The dining room carpets need attention: one was dirty, and the other had wrinkles which could be a problem for someone who shuffles. The bathrooms are now ready for redecorating, and once a decision has been made on the final location of the smokers’ lounge, this too will need to be decorated so it is presented to the same good standard as other communal areas. Some attention should be focussed on the garden which, though tidy, is uninteresting and gives residents less enjoyment than it might. Staff need to be made aware of the code of conduct set by the General Social Care Council, and the induction process needs to be reviewed, possibly through supervision. Staff must to remember to return personal toiletries to the resident’s bedroom after bathing, rather than leaving them in the bathrooms where they can pose a Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 6 potential risk to people who are confused. The Manager needs to think of a different way to keeping information relating to audits of accidents and injuries so that residents’ confidentiality is maintained. 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. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 8 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 standard(s) EVIDENCE: This section was not assessed on this occasion. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 9 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 standard(s) EVIDENCE: This section was not assessed on this occasion. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 10 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 standard(s) EVIDENCE: This section was not assessed on this occasion. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 11 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 standard(s) 16 and 18 The home’s complaints procedure ensures complaints and concerns will be acted upon, with the aim to bring about a satisfactory resolution. Staff recruitment, training, and supervision procedures ensure residents are protected from any form of abuse. A recommendation is made to monitor what is learned at induction, possibly through supervision. EVIDENCE: The complaints procedure is advertised widely throughout the building, and is clearly defined. Feedback sheets are also provided at reception so that visitors to the home can record their views or concerns. One complaint was recorded, following a point raised at a residents’ meeting. The matter had been discussed and an action plan had been developed to resolve the issue. No complaints had been received by the CSCI. A policy is in place relating to the Protection of Vulnerable Adults, that includes Whistleblowing (known at Thorley House as “Speaking out at work”). Two out of the three members of staff interviewed in the course of this inspection were clear about the content of the policy, and understood the home’s commitment to eradicating abuse or neglect in any of its forms. The third (newer) member of staff, despite covering the subject at induction, was less clear, and this lack of clarity was raised later by the Inspector with the person’s supervisor so that further training could be put in place. However, all three members of staff said they would have no hesitation in raising with senior staff their concerns about poor practice which might put residents at risk. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 12 As part of her National Vocational Qualification training, one member of staff had delivered an information session to her staff team on poor practice that could be seen as abuse or neglect, for example, telling someone to wait, preventing a person from leaving the building, or failure to report when someone is not eating. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 13 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 standard(s) 19, 20, 22, 23, 24, and 25. Thorley House is kept clean and, generally, is in a good state of repair – though one requirement has been made relating to dining room carpets, and three recommendations relating to the bathrooms, smokers’ lounge, and garden. Residents can be assured that they will live in comfortable, pleasant surroundings, and that they will be given any equipment, or alterations will be made, so as to maximise their independence. EVIDENCE: The home’s maintenance man assisted the Inspector during a tour of the premises. The grounds are generally well-maintained but are rather uninteresting, though it is understood that attempts have been made to secure funding to improve the presentation and accessibility for residents. One resident said they would like to see more colour in the garden. Staff thought the garden Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 14 was not used to its full potential, and spoke about the benefits that residents would gain from the inclusion of a conservatory and/or patio. Inside, the home was found to be clean and generally in a good state of repair. However, the bathrooms are now looking tired, with damage to the walls and dark staining above radiators and around extractor fans. The carpet in the main dining room was stained and requires to be deep-cleaned. The carpet in the small dining room has some wrinkles which could pose a trip hazard for a person with a shuffling gait, and requires attention. The room on the first floor that is now designated the smokers’ lounge would benefit from decorating as it is currently a mis-match of colours and patterns, making for a haphazard approach to design. The Home Services Manager said that some discussion has been taking place regarding the location of the smoke room which transferred from the ground floor at Christmas-time 2004. It would seem that residents who are smokers have taken to smoking in inappropriate places rather than going upstairs. Staff feel residents, therefore, are being restricted in their choice to smoke, and consideration is being given to relocating the smokers’ lounge back to the ground floor. Whichever way, a recommendation is made so that the presentation of the smokers’ lounge is no less equal to the presentation of other communal rooms in the home. The maintenance man said that staff have a good approach to reporting problems that occur around the home and that the system works well. If a light bulb needs changing, care staff will do it rather than leave a resident without. If the maintenance man cannot repair something, he said that a contractor will be called in. The maintenance man said there was no quibble about getting people in to fix things. There are sufficient toilets and bathing facilities to meet the needs of residents. Residents were able to direct the Inspector to toilets and bathrooms, and could explain how to lock toilet doors. The shower room on the first floor has been refurbished in the last 4-5 months with a new shower unit attachment and new seat for the shower stool. Specialist equipment is provided for residents as it becomes required, and a number of alterations have been made around the home so that residents are helped to maintain a good level of independence. There is only one motorised (Trixie) hoist so, very occasionally, a resident may have to wait until it becomes available. The visitors’ lounge on the first floor is used regularly. The room is bright and comfortable, and facilities are available for visitors and residents to make a drink. Bedrooms were seen to be clean and equipped to meet the needs of residents. Metal bed frames do look a little utilitarian, but a number of divan beds were Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 15 also seen. A number of bedrooms have been highly personalised. Staff knew how residents liked to have their bedrooms arranged. Residents are provided with keys to their bedroom doors, if they wish. Lockable storage space is available for each resident who wishes to keep safe any items that are valuable to them. One resident said that she had moved from a smaller room. She said she liked her new room, that it was clean and comfortable, and if she needed assistance, she could press a button and staff could come to help her. Heating and lighting throughout the home is good. Residents can adjust the temperature in their own bedrooms, and windows are large enough to allow natural light. Those window restrictors tested by the Inspector on this occasion were in good working order. Water is stored at the correct temperature. The maintenance man conducts a test of all water outlets in the home on a monthly basis. Those water outlets tested by the Inspector were found to be at or close to the recommended 43 degrees. Water systems are tested on an annual basis so that any risk from Legionella is prevented. On a monthly basis, the maintenance man flushes a solution through the shower system to combat Legionella. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. Residents are cared for by sufficient numbers of staff who have a good range of skills and experience. Additional staff are on duty at busy periods. Staff are trained and supervised so they are able to do their jobs properly. Recruitment of new staff is thorough. People who work at Thorley House have been properly checked out and have been deemed fit to work with vulnerable adults. Staff were not as aware of the General Social Care Council’s Code of Conduct as they should be, so there is the potential for residents to be open to poor practice. Some awareness training is, therefore, recommended. EVIDENCE: On duty during the period of this inspection, there were four members of staff responsible for delivering care (that is, one carer to every ten residents), plus seven ancillary staff working on domestic duties, in the kitchen, and on maintenance of the home. The home’s Manager was absent on holiday. The Home Services Manager, Susan Kenyon, who is responsible for the administration of the business, assisted with the inspection. The practice of employing two carers on duty through the night continues. Staff reported that additional members of staff had been on duty – either for all or part of a shift – in order to provide care to residents who had been unwell or, in one case, comfort to a person who had been at the end of their life. Speaking to staff, they said they felt that residents’ needs were being met at Thorley. From observation, though they were busy, it was seen that staff took Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 17 the time to stop and spend real time with residents, rather than simply providing care “in passing”. One member of staff described the recruitment process and said that she had been kept informed at all stages. She had not been allowed to start in employment until references had been taken up, and until a satisfactory check had been made via the Criminal Records Bureau. The member of staff described the induction process – which she said was thorough. She was able to explain what the induction programme was like and knew that it was in line with TOPSS standards. She had not been allowed to work unsupervised until such time as the Manager felt she was competent. None of the three members of staff interviewed during this inspection understood about the code of conduct and practice set by the General Social Care Council. None remembered receiving a copy of the code. Some general awareness raising for staff in relation to the GSCC is recommended. Training achievements are applauded by everyone at Thorley, and a copy of the training certificate is displayed on the ‘Wall of Fame’ outside the main dining room. Staff commented about wanting to get such-and-such so they could have another certificate on the wall. Residents liked the fact that they knew staff were training and developing. In questionnaires, residents had recorded their views that staff were “very helpful” and “friendly”, and that they “listen to you”. In correspondence, one relative had recorded his thanks to staff for their consideration, skill, patience and attention to detail. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35, 36, and 38 Thorley House is well-run and well-managed. There is clear leadership, and an open style of management that residents and staff appreciated. There are plenty of opportunities for residents to make their views known. Residents know they will be listed to. There are systems in place to make sure residents’ financial interests are safeguarded. Supervision and training of staff, regular staff meetings, and thorough monitoring of systems used in the building, make sure that residents and staff are kept safe. They way that accidents are recorded should be changed to maintain residents’ confidentiality. EVIDENCE: At the time of this inspection, the Manager was absent on holiday. This created no problems for staff, who were able to access any file required for examination. Staff were clear about what was expected of them. They understood the Manager’s ethos that gossip and exaggeration would not be tolerated, and that all members of staff were expected to work to the same Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 19 good standard. All three members of staff who were interviewed spoke about meeting residents’ needs and the need for staff to work together in order to achieve that aim. Staff knew about the home’s aim to achieve the Investors in People award, and appeared familiar with the aims of CLS as an organisation. The Manager, even in her absence, was held in high regard. She was described as “very open”, “trusting”, and “supportive”. Quality assurance and quality monitoring systems are in place, and were seen to be followed up formally on a monthly, quarterly, and annual basis. There are regular meetings with staff and residents, all of which are recorded. Attendance at staff meetings is good, with few apologies for absence being recorded. Informally, though, quality is checked on a daily basis with residents and their visitors so that if changes or improvements are found to be needed, arrangements can be made quickly. Residents are prepared to try something new or different, in the full knowledge that if it does not meet with their approval, they can make their feelings known. The majority of residents living at Thorley have made the decision to hand over control of their money to a relative or other supporter. A number of residents keep a small amount of “pocket money” in the office. Residents’ monies were checked and found to be in order. Mrs. Kenyon said that there are no problems receiving funds for residents – if a resident is running short, a quick telephone call to the relative is generally all that is needed. Two of the three members of staff interviewed during this inspection spoke about the types of supervision that they receive during the course of a year. This might be informal, on-the-job supervision, or formal supervision on a 1:1 basis with a senior person, or an annual appraisal with the Manager. Staff described what types of subject they might cover during supervision, and said that they always signed a copy of the report that was produced. Staff knew where their supervision paperwork was kept and could have access to it, on request to the Manager or person-in-charge. The third member of staff had not yet received any supervision other than on-the-job, and so was unclear about the process. From conversations with staff, and from a review of training certificates and the notes of staff meetings, it could be seen that considerable efforts are made to ensure that staff understand about safe working practices. There is a series of procedures – Safe system of work – for staff to follow. For example, for cleaning the spa bath, so as to prevent a build up of debris (hair, skin) in the water jets, and to preventing damage to the bath, and reducing the risk of cross-infection among residents. Supervision ensures that staff carry this through to their daily work. There are systems in place to ensure that equipment and services are maintained and serviced regularly. Staff understood about legislation supporting safe working practices, for example, Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 20 Control of Substances Hazardous to Health Regulations (COSHH), and Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). Staff should take care to return toiletries back to residents’ rooms after bathing. Risk assessments had been carried out to prevent accident or injury. Accidents and injuries had been recorded on the appropriate format and had been reported to the appropriate agencies. The paperwork is kept on an open file, but the office is locked at night. The current method of monitoring accidents compromises confidentiality of information and should be changed. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 3 x 3 3 3 3 x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x 3 3 x 2 Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 22 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 19 Regulation 23 Requirement The carpet in the main dining room must be deep-cleaned. The wrinkles must be removed from the carpet in the small dining room. Staff must ensure that residents personal toiletries are removed from bathrooms following bathing. Timescale for action 30th September 2005 9th September 2005 2. 38 13 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 18 Good Practice Recommendations The effectiveness of the induction programme should be monitored, possibly through supervision, to make sure staff have understood about the need to protect vulnerable adults. Consideration should be given to making better use of the garden. Bathrooms should now be scheduled for redecoration. The smoke room should be decorated to the same good standard as other communal areas. Awareness training for staff should be suitable in relation to the GSCC Code of Conduct. The Manager should consider a different way of keeping F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 23 2. 3. 4. 5. 6. 19 19 19 29 38 Thorley House accident audit records, so as not to compromise the confidentiality of residents data. Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 Page 24 Commission for Social Care Inspection Turton Suite, Paragon Business Park, Chorley New Road, Horwich, Bolton, BL6 6HG. 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 Thorley House F06 F56 S5765 Thorley House V230491 Stage 4 23.08.05.doc Version 1.40 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!