Inspection on 16/06/05 for Waltham House

This inspection was carried out on 16th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Waltham House 07/11/07

Waltham House 27/10/06

Waltham House 09/01/06

Waltham House 15/11/04

Waltham House 30/07/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Waltham House Louth Road New Waltham Grimsby DN36 4RY Lead Inspector Theresa Bryson Unannounced 16 June 2005 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. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Waltham House Address Louth Road, New Waltham, Grimsby, DN36 4RY 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) 01472 822864 Infinite Care Lincs Ltd Ms Jane Robinson CRH 18 Category(ies) of OP 18 registration, with number of places Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None apply. Date of last inspection 15th November 2004. Brief Description of the Service: Waltham House is a large old property on the outskirts of New Waltham close to the town of Grimsby. It is set in mature gardens with care parking space to the front for uo to 5 vehicles. The home is registered to provide care and support for eighteen older people over the age of sixty five and in no other catagory. The home has two storeys servcied by a stair lift. on the upper floor there are two sections that have further steps and therefore these areas of the home are only suitable for more ambulant people. There are four bedrooms in the middle section where there are no steps to negotiate, three double rooms and one single. There is one large sitting room, a dining room that also has comfortable seating, and a futher sitting room that leads to a conservatory. All of the communal rooms have open fires as well as central heating. The home has eleven bedrooms, one assisted bathroom and two shower rooms. Neither shower room is accessible to less ambulant service users. The home had a change of ownership in June 2004, who are planning an extensive refurbishment and extension of the property in the next few years. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day in June 2005. To find out how the home was run and if the people who live there were pleased with the care they got the inspector spoke to the manager, operations director, and 4 staff working in the home at the time of the inspection. The inspector also spoke to 4 people living permanently in the home and 2 relatives visiting. Paperwork kept in the home was also seen to make sure that the checks to make sure staff are safe to work in the home were done. Paperwork was looked at to make sure that the home and the things used in it were safe and were checked often. The manager of the home, Jane Robinson had been in charge for some time and has tried hard to make sure that what has needed to be done to have a safe place for service users to live and staff to work in had been completed. What the service does well: The home was very clean and tidy, had a friendly feeling and had lots of space indoors for people to relax, sit and eat in. The gardens were very large and could be reached by people in wheelchairs. The gardens were very colourful and free from hazards. The staff were very friendly and knew about the care the people living in the home needed. This also included the cook who was very well informed of the needs of all people in the home. The care people needed was written down by the manager with their help and checked by staff to make sure that there had been no changes. The people living in the home said that they really liked the meals, that there was plenty of different things to eat and if they didn’t like something they would be given something else. There was plenty of fresh fruit and vegetables in the storerooms and home baking on the shelves. The home had enough staff in the home at any one time to make sure everyone could be cared for and the people who lived in the home said that the Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 6 staff always came when they rang their bell. What has improved since the last inspection? What they could do better: The staff did not always write down how care was given on a daily basis and the daily report paperwork needs to be more detailed to give an accurate picture of what the people living in the home do each day. The manager said she checks the paperwork the staff write, but needs to make sure she records when she has checked. Most of the checks to make sure staff are suitable to work at the home have been completed. The manager was asked to make sure that checks had been made on all new staff and paperwork is kept on any volunteers in the home. This is to make sure that the people living in the home are well protected. The staff had completed a lot of training in the last year, but a programme is needed to make sure all areas are covered and this includes training on the protection of vulnerable adults. Most health and safety checks had been done by the manager, but paperwork could not be found for checking chemicals in use, testing the call bell system and the 5 year check for electrical wiring. The manager and directors of the company complete a number of quality checks each month but do not have a plan of: what they will be looking at, how they are going to do it and what Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 7 areas need urgent attention. This must also include a furniture and fittings check on all items in a person’s room, to make sure they have every thing they need. The company need to supply a business and financial plan so the inspector can see that the company is sound and in control of running the home. 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. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 and 6. The service users were provided with information regarding the home and always met a senior member of staff prior to admission. The statement of purpose and service user guide contained current details, and each service user had a current contract for the home. Staff demonstrated that they were well informed regarding the needs of service users at the time of admission, which assisted the service user to feel safe, secure and welcome, which assisted the service user to feel safe, secure and welcome. The home does not provide intermediate care and therefore Standard 6 was not applicable. EVIDENCE: The statement of purpose and service user guide had been corrected to show the new ownership. The last time these documents were revised showed a date of September 2004. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 10 The manager stated that she completes all preassessments with the operations director and in each care plan tracked there was written evidence of a comprehensive assessment tool, which had been used. This showed the date of assessment and planned admission dates. Staff stated that this tool gave them a guide knowledge base on which to start the care plan and service users all stated that they had felt very welcomed into the home and felt the staff knew a lot about them. The home does not provide intermediate care and therefore Standard 6 is not applicable. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 11 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) 7,8 and 9. The care plans were adequately developed and showed evaluations of service user needs. The comprehensive documentation was easy to follow and there was sufficient evidence to show that health care needs of the service users were being met. Deficiencies in the accuracy of transcribing medication and recording medication given to service users had been corrected. All records were legible and store cupboards clean and tidy. EVIDENCE: 4 care plans were tracked in depth as part of the inspection process. The care plans were laid out in an ordered manner and contained 11 different sections for staff to complete. Generally these had been completed to an acceptable standard. These are written by wither the operations director or the manager, with the key worker completing the monthly evaluations and daily report. It was easy for the inspector to follow through the actual delivery of care to service users and see whether all care needs were being addressed. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 12 The 4 service users spoken to in depth and 2 relatives all stated how kind the staff were and respected their dignity and privacy. They felt that at no time were their needs not met. The manager stated she checked the care plans regularly, but no documented evidence could be found. The daily reports were seen to be completed on a regular basis, but need further expansion to show all events taking place each day for every person in the home. The key worker notes were written on a monthly basis and also need further expansion. The last check by the home’s chemist was in November 2004 and the manager stated she felt able to go to him for advice. Each medication administration sheet included a photograph of the service user and all records were legible. The manager keeps a list for when each service user’s review is due with the local GPs’. Medication was seen to be kept in a secure place and the controlled drugs kept in a different place. These were checked and found to be correct. Policies for drug administration remain unchanged from the last inspection and all staff administrating medication have completed their training. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 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 standard(s) 15. The meals provided for service users were of good quality, offering choice and variety. The cook showed examples of good stock control and the kitchen and all storage areas were extremely clean. EVIDENCE: The last environmental health officer’s visit was at the end of April 2005 and the home was still awaiting the report. The cook stated that there were no major issues identified at the time of that inspection. Since the last inspection there had been a change in suppliers, which the cook was dealing with some minor teething problems. She stated that the budget was adequate to meet the kitchen needs. There was ample evidence in the store cupboards of good stock control and all areas were clean and tidy. Temperature controls were seen to be recorded on a regular basis. The service users spoke positively about the meals provided and described the quality, choice and variety of the meals as good or very good, with their individual choices being met. The kitchen was catering for diabetic and vegetarian diets, as well as the normal menu. The current day’s menu was on display near the dining room and main sitting rooms, but for those unable to see the blackboard service users stated it was read to them by staff. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 14 Staff were seen to assist service users in an appropriate manner, which respected the privacy and dignity of the service users. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 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 standard(s) 17 and 18. The documentation to inform staff of service users legal and civic rights was in place and each person is on the local electoral role. Evidence to support that all staff had been trained in protection of vulnerable adult policies was not produced, and this included the manager. Polices showed adjustments made to support the local authority guidelines and current legislation. EVIDENCE: The home had ensured since the last inspection that all service users were now included on the local electoral role list and evidence was in each person’s care plan documentation. Evidence was seen in 12 staff training files that they had completed protection of vulnerable adult (POVA) training in 2004. 8 staff had not completed plus the manager. The manager needs to complete her up date training to enable knowledge to be passed down through all staff groups in the home and so she can be a source of information should the need arise. Details of how to make a referral to the local POVA team were on display. The home has adapted its own policy to include the local guidelines and current legislation. When asked by the inspector staff gave mixed responses on how they would make a referral. The manager must ensure that all staff have the same knowledge base to know how to make a response. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 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 standard(s) 19,24 and 26. The home was clean and tidy and the manager proactive in meeting requirements and maintaining the home. EVIDENCE: The manager provided a maintenance and renewal programme for the home, which covered both minor and major works planned. This had been revised in December 2004. The manager stated that the owners’ were supportive of any suggestions made locally for improvements to the home. Discussions are still on going for possible future expansion of the home and improved communal space. The home was clean and tidy. Staff stated areas they are to maintain on a cleaning schedule, but informed the inspector that there was enough time to perform these tasks each day. There was a cleaning schedule in place for night staff, but the manager informed the inspector that these tasks do not have to be completed, as service user needs would always come first. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 17 Whilst touring the home a selection of bedrooms was inspected. There was ample evidence that service users are able to bring in their own possessions. Service users themselves stated that this made them feel welcomed and helped them to settle into the home. The director of care completes an audit tool monthly, which was seen, which includes room checks. The company still has to complete an assessment on the furniture and fittings in each room for each service user. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 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 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) 27,28,29 and 30. The staffing levels were appropriate for the current dependency of the service users accommodated. Whilst there was evidence that training had taken place there was no programme to show forward planning. New staff needed adding to the record of training on the home’s booklet. The manager is still awaiting decisions on a number of staff that are currently undergoing NVQ training. The home’s recruitment practises had not been adequately implemented in all cases to ensure a sufficient protection of service users. This included current staff and a volunteer. EVIDENCE: The current staffing rotas were seen and showed a good skill mix on duty each day. Staff stated they felt enough staff were on duty to be able to complete the tasks for each service users needs and service users stated they felt all their individual needs were being addressed daily. There was a monthly evaluation of dependency levels in each service users care plan. The manager was awaiting decisions on individual staff members from a training college to indicate whether their NVQ courses were complete. She is aware of the target timescale to complete 50 of her staff by the end of 2005. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 19 4 staff personal files were inspected in depth during the course of the visit. Contracts for all staff have still to be sorted out with the new owners. No staff required a work permit. The manager could not provide evidence that at least one staff member had a POVA first check completed prior to commencement of employment and was asked to check this with the operations director that day. Other criminal investigation bureau checks were produced as written evidence to support their completion. The home has one volunteer, but no documented evidence could be produced to support that the relevant checks had been completed on this person to protect the service users. The staff interviewed were very experienced carers and had received a variety of training. They were able to give a good account of service users needs, when asked. The home had recently had a visit from the company helping them with their Investors in People award and the manager stated that they are assisting the home in putting together a training programme, which will cover statutory, service specific training and individual staff needs. The manager produced a booklet, which showed training undertaken for all staff. New staff had yet to be added to the book. This showed training taken place in a variety of statutory and service specific topics in the last year. Individual staff spoken to were able to inform the inspector of training they had undergone in the last six-months, which covered several different topics. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 20 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) 31,33,34,35 and 38. The manager was showing due diligence by ensuring that all health and safety checks are completed on a regular basis and service contracts are in place. Improvements were needed in three areas were evidence could not be produced. The evidence was poor to enable the inspector to assess that good control was being maintained by the company over financial aspects of running the home and forward planning. This includes the absence of a business and financial plan and annual development plan around quality controls in the home. EVIDENCE: There was evidence from talking to the manager that she has updated her self in most aspects of current practise in the home in the last year. She has still to complete her Registered manager’s award. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 21 The owners send to the CSCI regular Reports under Regulation 26, which are very detailed and informative. The operations director completes a quality assurance audit on a monthly basis, some of which was seen in documented form on the day of the visit. The home still has to produce an annual development plan and show they are using a verifiable tool for their quality audits. The company is currently being helped to complete its Investors in People award and is being assisted in putting together a variety of useful auditing tools, including a training programme for staff. The business and financial plan for the company was not available on the day. The manager was able to give a good account of the financial processes for keeping service users personal money in the home. All financial records were kept in a secure environment. 3 service users balances were checked and found to be correct. A number were seen to have credit balances and the manager stated that some families are slow in responding to requests to meet service users individual financial needs for such items as hairdressing and chiropody bills. As a matter of good practise the manager was advised to contact the local authority if she had any major concerns to prevent financial abuse by those holding the money of individuals and/or take legal advice for those privately funded. The manager was able to produce documented evidence that the majority of certificates were in place for equipment to ensure adequate health and safety checks had been completed in the home. Three items could not be produced, electrical wiring certificate, nurse call system and COSHH assessments. An adequate training programme could not be produced. Accident records documentation showed follow through in the care plans and any problems identified had been addressed. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x 2 x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 2 2 x 2 2 3 x x 2 Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15.2.a,b,c ,d. Requirement The registered person must ensure that the service user care plan is kept under review and there is evidence to support that audits are completed. The registered person must ensure that all staff have undergone up dated training in the protection of vulnerable adults. The registered person must ensure that all service users have been assessed for the use of furnture and fittings. (Previous timescale of30/03/05 not met). The registered person must ensure that a POVA first check has been completed on all staff before employment and all volunteers have complete record files open for inspection. The registered person must ensure that the training programme includes all mandatory and service specific training. (Previous timescale of 30/03/05 not met). The registered person must produce a report detailing the Timescale for action 2nd December 2005. 2nd December 2005. 2nd December 2005. 2. 18 13.6. 3. 24 23.2.f. 4. 29 18.1.a. 2nd September 2005. 5. 30 18.1.c,i and ii. 2nd September 2005. 6. 33 24.1.a and b. 2nd December Page 24 Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 7. 8. 34 38 25.1. 13.4.a.b. and c. results of quality assurance surveys and an annual development programme (Previous timescale of 01/06/05 not met). The registered person must produce an up to date buisness and financial plan. The registered person must ensure that safety and environmental issues affecting service users welfare and mentioned in areas of the report are addressed. (Previous timecale of 30/03/05 not met). 2005. 2nd September 2005. 2nd December 2005. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 28 31 35 Good Practice Recommendations The registered provider should ensure that 50 of care staff are working towards the target of achieivng their NVQ level 2 care awards. The registered manager should continue to work toawrds the Registered managers award. The registered provider as a procedure for good practise should ensure that all service users do not fall into a credit position in the personal allowance money held at the home. Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Waltham House J54 S57503 Waltham House V232962 16 June 05 Stage 4.doc Version 1.30 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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