Inspection on 06/09/07 for Vartry Road, 18

This inspection was carried out on 6th September 2007.

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

Other inspections for this house

Vartry Road, 18 07/08/06

Vartry Road, 18 17/10/05

Vartry Road, 18 03/05/05

Vartry Road, 18 05/10/04

Vartry Road, 18 29/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Vartry Road, 18 18 Vartry Road London N15 6PT Lead Inspector Stephen Boyd Key Unannounced Inspection 6th September 2007 09:30 Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 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 Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vartry Road, 18 Address 18 Vartry Road London N15 6PT 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) 020 8802 8700 020 8299 4818 vartry@choicesupport.org.uk www.choicesupport.org.uk Choice Support ** Post Vacant *** Care Home 4 Category(ies) of Learning disability (0) registration, with number of places Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2006 Brief Description of the Service: 18 Vartry Road is registered as a care home providing personal care for people between the ages of 18 and 64 who have learning disabilities. Choice Support is the registered provider. The home provides accommodation and support for four peoplean d is situated in a residential area of Haringey close to shops and transport facilities near Seven Sisters’ Road. St. Ann’s Hospital is about a mile away. The stated aim of the home is to ensure for people using the service: presence in mainstream community life, choice, competence, participation, respect, individuality, flexibility, co-ordination with other agencies and racial, cultural and religious sensitivity. The premises consists of a two-storey terrace house with three single bedrooms on the first floor and one single bedroom on the ground floor with en suite facilities, with the remaining being provided with washbasins. The kitchen, laundry area and dining / lounge rooms are all on the ground floor. There is a private back garden, which is partially paved and grassed. The office area situated on the first floor also doubles up as a sleeping in room. A second sleeping in room is on the ground floor. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The cost of placements is £1,133.44 per week. There are additional costs for water cooler, massage therapy and chiropodist. Following Inspecting for Better lLves the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in one day in September 2007. I was pleased to meet with one person living in the home. The other three people were out at day services. I also met with two members of staff and was also assisted by a service manager of the “Choice” support organisation. A tour of the premises was undertaken and various records and policies were viewed. After the inspection took place, I contacted a relative of one person living in the home to ascertain their views on the service. What the service does well: What has improved since the last inspection? What they could do better: This inspection highlighted that three requirements from the previous inspection had yet to be demonstrated as met. A further five new requirements have been made as a result of the visit. Due to staffing records being unavailable, I was not able to determine whether requirements relating to Criminal records bureau and POVA checks had been carried out. I was not able to ascertain whether the recruitment processes of the home were suitable and Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 6 adequate. Not all staff working in the home had received training in the protection of vulnerable adults. The home needs to ensure that people or their representatives show ownership and involvement in the care planning process by signing plans in the space provided. Some changes to the premises are needed in terms of maintenance and improvements (see standard twenty four for detail) The provider needs to make application to the CSCI to seek registration of the current manager. The quality assurance system used for the home needs to have results collated that are specific to the home and not to a group of services. A certificate of gas safety needs to be available for inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to ensure any prospective person wishing to live at the home would have their needs assessed. EVIDENCE: The home has not admitted any new people for a number of years. The home has policies and procedures in respect of prospective new residents which would be implemented if new people were to be admitted. This includes an assessment process to ensure that individuals’ needs could be met. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service have individual plans of care. People make decisions about their lives where able and are assisted appropriately. Risk is managed effectively for people living at the home. It is a principle that people should be enabled to undertake ordinary life pursuits. EVIDENCE: Each person living at the home has an holistic support plan. These were seen and all indicated people’s individual needs and how these were to be met. The plans were seen to be reviewed at least every six months. The home is moving towards adopting a person centred planning approach in the next months. One area of the planning process, which needs to be improved, is to ensure that people if able or their representatives denote ownership and awareness of plans by signing them in the space provided on the documents. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 10 People living at the home can make decisions about their lives with assistance from staff on a day-to-day basis. For example, what to eat, what to wear, when to get up, where to sit, what activities to follow etc. Support plans show examples of this in respect of activities. Each person was seen to have risk assessments relating to their individual needs and conditions, for example Epilepsy. The risk assessments clearly indicated that strategies were in place to minimise risk to people and others, whilst at the same time retaining the principle of ensuring people had as much control and independence as possible over their lives. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are able to pursue a range of activities, many of which take place in and around the local community. People living at the home have appropriate contact with family or advocates. People have their rights respected by the staff in their daily lives. People living at the home enjoy a variety of appropriate and healthy meals. EVIDENCE: Each person living at the home has a programme of activities to follow. At the time of the visit three people were attending day activities at a centre where they attend five days per week. People enjoy going for walks, visiting shops, pubs and restaurants in the local vicinity. Some people attend a Monday evening club. Within the home, people enjoy puzzles, music, foot spa and sensory activities. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 12 Two of the four people living at the home have fairly regular contact with their family members. The other people have advocacy arrangements via a local Mencap service. I spoke with one relative after the inspection who said they were very happy with the way their relative was cared for at the home. They praised the staff and said they felt involved and informed by the home. Although their relative had communication difficulties, they felt he looked happy and content when they visited. People’s rights were seen to be respected during the inspection. Staff were observed treating one of the people in an appropriate manner and were seen for example to knock on their bedroom door and announce themselves before entering. Menus seen during the inspection indicated a healthy and varied diet was on offer. Food stocks further evidenced a range of healthy foods were available such as fresh fruit, vegetables, yoghurts etc. An individual record of what each person has eaten is kept. Temperatures are recorded for fridge and freezers as part of food safety in the home. Dietician advice has been sought with respect to individuals and menu planning. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personal support is provided in an individual way to people living at the home. Each person’s health needs are given a good level of priority. The home operates an appropriate medication system. EVIDENCE: How people need and prefer various personal support tasks to be carried out is identified in their individual support plans. Each person has a key-worker to individualise care. Staff working in the home have a good knowledge of people and their needs. There is not a great reliance on using staff unfamiliar with the people living in the home. Each person living in the home has their own health booklet. This details individual health issues and how these need to be monitored and dealt with. Health record sheets are kept which detail appointments and outcomes with a range of health professionals including Doctors, dentists, Opticians and specialist consultants. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 14 The home operates a monitored dosage system of medication administration. This was found to be operating appropriately at the time of the visit. Administration records were correctly completed and the medication was kept safely and securely. Staff have received training in the system and safe administration, uses and side effects. I would recommend that where bottles of medicines are held, start dates are recorded on them to allow for better auditing. None of the people living at the home are able to self- administer their medication. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies and procedures in respect of complaints. Although the home has a suitable policy and procedure to deal with protecting vulnerable adults, this needs to be backed by ensuring all staff are trained in how to recognise and report incidences that may occur. EVIDENCE: No complaints regarding the home had been recorded since the previous inspection. A policy on complaints was available, although the senior carer could not locate the pictorial complaints format at the time of the visit. The relative spoken to after the inspection indicated they had no complaints or concerns, but would know how to complain if they had. The home had a policy and procedure in respect of protecting vulnerable adults from abuse. This made reference to the policy and procedure of the local London borough. Most but not all staff working in the home had received training in POVA issues. Similarly, this was the case for training in challenging behaviours. A requirement in this respect is restated in the report as not all staff had received this training at the time of the previous inspection. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The premises are generally comfortable and safe. Some areas need improvement to raise the standard. The home was clean and hygienic. EVIDENCE: The home was seen to be generally comfortable, clean and warm at the inspection. Rooms of people living there were personalised with photographs, pictures, ornaments etc. Since the previous inspection, the lounge and kitchen had been redecorated. The bathroom has been converted to a shower room. A new TV had been purchased. The inspection did highlight some areas for maintenance and improvement. In one bedroom a window lock was broken. A ramp is required at the front door to facilitate ease of access for one person with mobility issues. The downstairs toilet was seen to be in need of redecoration. Staff commented that the boiler was regularly breaking down causing problems for heating and water. The Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 17 kitchen was showing signs of wear and tear and a new installed kitchen is advised. A requirement to address these issues is made in the report. Policies on infection control were available. Staff spoken with intimated they had no problem in getting cleaning materials and items such as gloves and aprons. At the time of the visit there were no unpleasant odours in the home to intimate any problem with hygiene. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff working in the home are competent and generally well qualified. The home was not able to demonstrate that people are protected by the homes recruitment policies and practices at this inspection. EVIDENCE: Staffing levels at the home provide a minimum of two staff on each shift. Numbers rise to three when more people are at home and not at daytime activities. At night there is now a waking member of staff to complement the sleep in person. Staff spoken to presented as competent and with good knowledge of peoples needs. Most have worked at the home for a considerable length of time. More than fifty percent of staff have national vocational qualifications in care at level two or above. Training records indicated that staff have undergone a range of pertinent courses to enhance their knowledge and ability to meet the needs of people living in the home. Such training has included: Food hygiene, health and safety, Epilepsy, Fire safety, First aid, moving and handling and Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 19 infectious diseases. As indicated earlier in the report, more training in relation to POVA and challenging behaviour is required. Unfortunately, at this inspection there was no access available to required staff records. The manager was on leave and a key was not available to anyone else. Thus I was not able to determine through written records such as application forms, references, Criminal record checks, identity details etc that thorough recruitment and selection processes were being followed. There had been gaps in these records identified at the previous inspection and thus two requirements are restated. Staff spoken to did indicate they had undergone interviews and checks had been made on them. They also stated they received regular supervision and it was evident through minutes, that staff meetings took place. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home generally live in a well run home. This needs to be further demonstrated by having a registered manager whose qualifications; experience and suitability have been tested by a registration process. The home needs to ensure its quality assurance procedures are individual to the home. Health, safety and welfare matters are generally well promoted, although safety certificates must be available for all installations. EVIDENCE: The home has a manager who is not currently registered. The service manager on behalf of “Choice” was advised an application needs to be made to the CSCI to seek this persons’ registration. Staff spoken to were positive about the abilities of the manager in running the home and in the way they were supported by both the manager and provider organisation. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 21 The home does have quality assurance processes in place, which includes an internal annual audit. However, the home is grouped with other “Choice” services for external auditing, which means when results are collated, including views of stakeholders the outcomes are not specific to Vartry Rd. For example, if eighty percent of people say they are happy with the service provided, this figure could be greater or less for individual services and thus not giving a specific picture. A requirement is made to this effect. Certificates of safety were seen to be available for water safety, fire equipment, portable appliances and electrical installation. A certificate of gas safety could not be located during the visit and a requirement to have an up to date one available is made. Staff have attended health and safety courses and risk assessments were available on areas of the home. Apart from the areas identified in standard twenty-four of this report, no other safety issues were identified during the inspection. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 23 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 YA6 Regulation 15 (1) Requirement Timescale for action 31/10/07 2. YA23 13(6) The registered person must ensure that each person or their representative signs their plan of care as evidence of involvement in care planning. 30/11/07 The registered person must ensure that all staff undertake Protection of Vulnerable Adults training (POVA). This must be in line with the local authority’s procedures. Also training in how to deal with challenging behaviour. This is a repeat requirement. Previous timescale of 30/09/06 not fully met. The registered person must ensure that the premises and equipment therein are suitable and safe for people living and working in the home. See standard twentyfour for specific details. The registered person must not employ any further person to work in the care home in any capacity without first obtaining a satisfactory DS0000060634.V348852.R01.S.doc 3. YA24 23(2) C&N 31/12/07 4. YA34 7, 9, 19 Sch 2.7 31/10/07 Vartry Road, 18 Version 5.2 Page 24 CRB Disclosure check including a POVA check along with other information required by regulation. All staff employed since 27th July 2004 without an enhanced CRB Disclosure that includes a POVA check, must only work under the individual and direct supervision of a named staff member who has been appropriately checked This is a repeat requirement as unable to ascertain if this had been met. Previous timescale to be met was 30/09/06 5. YA34 7, 9, 19 Sch 2 The registered person must ensure that recruitment procedures are followed and evidence of this is available on each staff members file. This is a repeat requirement as unable to ascertain if this had been met. Previous timescale to be met was 30/09/06 The registered person must make application to the CSCI to seek registration of the manager of the home. The registered provider must ensure that any system of quality assurance used for the home is specific to the home and results can be easily identified. The registered person must ensure an up to date certificate of gas safety is available for inspection 31/10/07 6. YA37 8&9 31/10/07 7. YA39 24(1) 31/12/07 8. YA42 13 (4) (a) 31/10/07 Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 25 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 YA20 Good Practice Recommendations The manager should record dates on bottles of medicines to allow for better auditing of medicines used. Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Vartry Road, 18 DS0000060634.V348852.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!