Inspection on 26/02/06 for Walkden Manor

This inspection was carried out on 26th 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

Walkden Manor 18/02/09

Walkden Manor 15/01/08

Walkden Manor 03/07/07

Walkden Manor 23/10/06

Walkden Manor 12/05/05

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 Walkden Manor 41 Manchester Road Walkden Worsley Gtr Manchester M28 3WS Lead Inspector Adele Berriman Unannounced Inspection 26th February 2006 10:40 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 Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 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. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Walkden Manor Address 41 Manchester Road Walkden Worsley Gtr Manchester M28 3WS 0161 790 9951 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) Walkden Manor Care Home Ltd Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 29 Older People (OP) requiring personal care only may be accommodated Care staffing levels will not fall below the minimum levels set out in the Residential Forum Guideance for Staffing in Care Homes for Older People. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 12th May 2005 Date of last inspection Brief Description of the Service: Walkden Manor is a residential care home situated in the centre of Walkden, Salford. The home provides personal care only to people over the age of 65 years. Bedrooms are situated on the ground and first floor of the accommodation with the laundry, office and main kitchen located in the basement. There is a large flagged patio area to the rear of the home and a small car park situated at the side of the building. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26 February 2006 over a six-hour period. The inspection involved spending time talking with the senior carer and staff of the home who were on duty at the time. Some time was also spent talking with a number of residents who wanted to say how they found living in the home. Some time was spent looking at files, available records and some policies and procedures. However, the manager was not on duty at the time of the inspection and the senior carer does not have access to staff files so these were not be examined. The inspector also had a look around the inside of the home as well as having a walk around the outside of the building. At the last inspection, which was done in May 2005, a number of improvements were identified that needed to be carried out. A number of these had been completed when checked at this inspection. However, where these improvements had still not been done they have been included again in this report. Not all standards were checked at this inspection and it is strongly advised that this report should be read together with the last inspection report in order to get a fuller picture of how the service is meeting the needs of the residents living there. What the service does well: What has improved since the last inspection? Care plans had been further improved and contained much more detail. New staff have been employed in the home to cover laundry and cooking duties. This means that care staff will not be taken away from their own duties in order to work in the laundry of kitchen. The availability of social and recreational activities has improved in the home. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 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 the following standard(s): 1,2, 3 and 6 Information was available for a prospective resident to make an informed choice about where to live. Pre-admission assessments were taking place and residents informed of costs to live in the home. EVIDENCE: A copy of the homes Statement of Purpose and Service User Guide was available in the home. These gave relevant information about the home to any person considering living there. Each resident was provided with a statement of terms and conditions outlining the costs for living in the home. A number of resident files were examined including that of a recently admitted resident. This was found to contain a pre-admission assessment that had been carried out and included information that would support care staff to develop an appropriate care plan. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 9 Individual records are kept for each resident and since the last inspection carried out in May 2005 a great improvement in how records are maintained and recording is carried out was noted. Walkden Manor does not offer intermediate care facilities. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 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 and 10 Although progress had been made in developing and improving arrangements to ensure that the health and care needs of residents are fully identified and met further improvements are still required. Poor medication practice could place residents at risk. EVIDENCE: Each person living in the home had an individual care plan on his or her file and since the last inspection these have been moved to a more accessible location for staff to use on a daily basis. A new ‘work station’ has been created on the ground floor corridor in order that staff has a suitable and accessible space in which to complete the daily records/diary and still be within easy access to residents and visitors. Five care plans were examined, one of which was for a resident recently admitted to the home and information had been provided via care assessments that had been carried out prior to admission into the home. Although most care plans seen contained good detail, further information was required to ensure that staff fully understood how support was to be given to each resident. Individual needs described in some care plans needs further Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 11 clarification to indicate to staff how best to provide support to meet those needs in the most appropriate way and to ensure that the preferred choice(s) of the individual are met wherever possible. The manager reviews care plans on a monthly basis. However, not all parts of the care plan recording system was being completed by staff e.g. personal hygiene record (baths etc) and this could mean that some residents may not receive the care and support they require in the most appropriate way. Each resident had a ‘daily record sheet’ that is completed by staff. Staff make entries to communicate relevant information about what sort of day an individual resident may have had, how well they have eaten and how personal needs have been met. Evidence was available to indicate that other health care professionals such as district nurses and doctors visit the home on a regular basis to help maintain the health of the residents living there. Medication was stored in a lockable trolley. Since the last inspection, senior staff with the responsibility for administering medication has received training from the supplying pharmacy (Boots). Each senior has an individual role in the management of medication in the home. One has the responsibility for placing medication orders and the other for recording medication received into the home or returned to the pharmacy. The pharmacy carried out an audit of medication practice in the home on 4 October 2005. Medication Administration Records (MAR) were checked and a number of concerns were identified. Where a printed MAR was not available for a resident, staff had completed a handwritten one. However, information was incomplete and some changes to the dosage of some medication had been made but the person making those changes had not signed the MAR. This could place residents at risk. A number of gaps were apparent on the MAR for the lunchtime medication administered on 25 Feb 2005. Medication had been administered but the records not signed. This could place residents at risk. It was difficult to complete an audit of controlled medication as numerous boxes of the same medication were in use for the one drug being administered that was controlled. This could lead to errors being made in the administration of such medication and could place the resident at risk. The policy and procedure relating to medication administration must be reviewed and be updated if required and all staff with the responsibility for administering medication must adhere to these procedures. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 12 Observation of staff during the inspection gave a clear indication that resident’s privacy and choice was being respected and residents spoken to made positive comments about the care and support they received from the staff team. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Improvements had taken place in the way in which recreational activities are offered and take place in the home. Information is available to residents to promote and offer support regarding choice and control over their lives however, further information is required. EVIDENCE: Since the last inspection was carried out a review of social and recreational activities taking place in the home had taken place. Activities are now available in the home every day in the afternoon. Staff are allocated to support activities taking place on the daily ‘job sheet’. Activities advertised included: reminiscence, bingo, ludo, dominoes, nail care and videos. There was no evidence available that information was given to resident’s families, friends and representatives regarding the homes policy on maintaining their involvement in the resident’s life. Nor was there evidence that resident’s had access to the homes policy with regard to accessing their personal records. Residents need to be made aware that they can access their records at any time. Families and friends need to be made aware that the home promotes them maintaining involvement in residents’ lives whilst they are living at Walkden Manor. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 14 Residents spoken to during the inspection said that the food was very good and the inspector viewed the lunchtime meal, which looked appetising. Since the last inspection was carried out a weekend cook has been employed and this has had a positive effect on staff availability in the home. Care staff no longer have to cover cooking duties at the weekend thus allowing more time to concentrate on care only duties. It is commendable that the home has achieved a ‘Silver’ award for food hygiene from Salford Council. This certificate is displayed in the foyer of the home. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 15 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): 16 and 18 Complaints were dealt with appropriately. The lack of information and awareness training of adult protection policies and procedures does not ensure that people living in the home are protected from abuse. EVIDENCE: The home had a detailed complaints procedure and, since the last inspection, the system for recording complaints had been further developed. Information regarding making a complaint was clearly displayed in the foyer of the home and any complaints made are recorded and managed by the manager. Representatives of Age Concern had visited the home and left information for residents and their families regarding advocacy services. This information was displayed in the foyer of the home. The home had a copy of Salford Social Services Adult Protection Procedure. The home had a policy on adult abuse that informed staff on what actions to take in the event of an act of or suspicion of abuse occurring. However, as identified during the last inspection, this information was not readily available to staff. This policy is required to be accessible at all times to staff to ensure that the correct procedure is followed. No staff had received adult protection awareness training. All staff are required to receive awareness training in adult abuse. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 16 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): 19,24, and 26 Some improvements had taken place in the overall presentation of the home, however there are a number of matters outstanding that require addressing in order to provide a safe and comfortable environment in which to live. EVIDENCE: A number of requirements made at the last inspection were found not to have been addressed and these, therefore, have been reiterated in this report. It was noted during a tour of the premises that some areas had a slightly unpleasant odour and an audit of the premises must be carried out to ensure that any unpleasant odours are eradicated to ensure that appropriate levels of cleanliness are maintained for the health and comfort of the residents. A number of bulbs in light fittings around the home were not working and a full audit of all light fittings must be carried out and new light bulbs fitted where required to ensure the health and safety of all living and working in the home. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 17 The flooring in the ‘smoking room’ was damaged near to the door and must be repaired to eradicate any hazard to both residents and staff. Wallpaper in several areas of the home required replacing. An audit of all decoration throughout the home must be undertaken and a programme of redecoration planned as part of the programme of maintenance of the home. Hot water provision in some rooms could be hotter and a full audit of all hot water provisions in the home that is accessible and used by residents must be undertaken to ensure that hot water temperatures do not exceed 44°C or are not too cold. Risk assessments must be in place where required. The kitchen on the ground floor that was undergoing refurbishment at the last inspection has still not been fully completed. This must be done to ensure that the health and safety of staff working in the kitchen is not compromised. Some communal toilet seats were found to be ‘chipped’ presenting a risk to individuals’ health and wellbeing. The patio doors on the 2nd floor require a balcony/safety rail fitting to the exterior side. Although these are not ‘normally’ accessible to residents it still remains a potential health and safety hazard should a resident gain access to them. The exterior of the building such as the car park and garden areas need tidying up and the old dishwasher and boiler need removing to prevent a hazard to anyone accessing those areas. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 18 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): 27,28 and 30 Staffing levels were appropriate to meet the needs of the residents. Staff files were not accessible on the day of the inspection. EVIDENCE: On the day of the inspection the number of care staff on duty was sufficient to meet the needs of the residents. Staff rotas also demonstrated that during the day and evening appropriate numbers of staff were employed in the home. Since the last inspection the manager has employed a designated laundry worker (18 hours per week) and a weekend cook. Staff spoken to during the inspection commented that this has made a great improvement in their work and their availability to meet the care needs of the individual resident’s. Staff files were not accessible on the day of the inspection and requirements made at the last inspection have been reiterated in this report. Although training records were unavailable for inspection there was evidence that training had been arranged/taken place on various dates and covered various work related subjects such as moving and handling and first aid. Relevant certificates were displayed in the foyer of the home. The home is also working towards the Investors in People Award. Staff spoken to say that the manager supported them in their role. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 19 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): 33 and 38 Development of a quality monitoring system is required to promote and safeguard the health, safety and welfare of the people using the service. The health, safety and welfare of residents and staff is not always appropriately maintained and monitored. EVIDENCE: It was evident that a lot of work had taken place since the last inspection in developing risk assessments relating to the premises and tasks that staff may carry out as part of their ‘normal’ work role. This included risk assessments relating to: * * Food preparation – storage, cooking and cooling food Slips, trips and falls DS0000062619.V262645.R01.S.doc Version 5.0 Page 20 Walkden Manor * * * Use of dishwasher, refrigerator/freezer Floor coverings Medication However, these risk assessments were not signed or dated by the assessor and no review dates had been set. A number of doors were ‘wedged’ open to a number of rooms throughout the building creating a potential hazard should the fire alarm be activated. Doors must not be ‘wedged’ open. Some areas of health and safety were not being monitored appropriately. There was no record of recent fire drills or fire appliances/bell tests. Regular testing of fire detection equipment/alarm is required to take place and be recorded appropriately. Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 x X X X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement Service users care plans and risk assessments must be developed to include information relating to all aspects of services users life. They must also identify the most appropriate way support is to be given and to ensure that the preferred choice(s) of the individual are met wherever possible. A full audit of controlled medication must take place on a regular basis. The registered person is required to ensure that there is a policy and staff adhere to procedures, for the receipt, recording, storage, handling, administration and disposal of medicines (Previous timescale 14/08/05 not met). Written information is required to be given to service users families, friends and representatives regarding the homes policy on maintaining their involvement in the service users life (Previous timescale 28/08/05 not met). DS0000062619.V262645.R01.S.doc Timescale for action 26/05/06 2 3 OP9 OP9 13 13 01/03/06 26/05/06 4 OP13 16 26/05/06 Walkden Manor Version 5.0 Page 23 5 OP14 12 6 OP18 13 7 OP18 13 8 OP19 23 9 OP19 23 10 OP19 13 11 12 OP19 OP19 23 23 13 14 OP19 OP21 23 23 15 OP24 23 The homes policy regarding access to personal records is required to be accessible to service users at all times (Previous timescale 28/08/05 not met). All policies and procedures relating to adult protection are required to be accessible to staff at all times (Previous timescale 14/08/05 not met). It is required that all staff undertakes awareness training on adult abuse (Previous timescale 28/08/05 not met). It is required that the refurbishment work on the ground floor kitchen is completed (Previous timescale 28/08/05 not met). An audit of all decoration in the home is required and where identified, redecoration takes place (Previous timescale 28/08/05 not met). A balcony/safety rail is required to be fitted to the patio doors on the 2nd floor of the home (Previous timescale 14/08/05 not met). The flooring in the smoking room must be repaired. A full audit of bulbs in light fittings around the home must be carried out and bulbs replaced where needed. The car park and garden areas must be tidied and the old dishwasher and boiler removed. A full audit of toilet seats is required and replacements fitted where required (Previous timescale 14/08/05 not met). It is required that all hot water provisions available to service users do not exceed 44 degrees. The temperatures are required to be checked and recorded on a DS0000062619.V262645.R01.S.doc 26/05/06 26/05/06 30/06/06 26/05/06 26/05/06 26/05/06 03/03/06 01/03/06 26/05/06 26/05/06 26/05/06 Walkden Manor Version 5.0 Page 24 16 OP26 13 17 OP28 Sch 2 18 OP30 18 19 OP33 24 20 OP38 13 21 22 OP38 OP38 23 23 weekly basis. An audit of the premises must be undertaken to ensure that any unpleasant odours are eradicated. All staff files are required to contain all the documents required by the Care Homes Regulations (Previous timescale 28/08/05 not met). It is required that a training record for each staff member is available at all times and that the home develops an on-going training programme (Previous timescale 28/08/05 not met). The registered person is required to devise and implement a system for the monitoring of quality assurance (Previous timescale 28/08/05 not met). It is required that a full audit of maintenance contracts and monitoring of health and safety related practices takes place to ensure that general health and wellbeing of all (Previous timescale 14/08/05 not met). Fire doors must not be ‘wedged’ open. All wedges must be removed. Fire bell/equipment checks must take place on a weekly basis and the outcomes of these checks be recorded. 26/05/06 26/05/06 26/05/06 26/05/06 26/05/06 01/03/06 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Walkden Manor DS0000062619.V262645.R01.S.doc Version 5.0 Page 26 - 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. 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