Inspection on 06/02/06 for WCC - The Lawns

This inspection was carried out on 6th 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

WCC - The Lawns 30/10/08

WCC - The Lawns 18/07/07

WCC - The Lawns 19/09/06

WCC - The Lawns 15/08/05

WCC - The Lawns 10/03/05

WCC - The Lawns 08/12/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Lawns 1 Gleave Road Whitnash Leamington Spa Warwickshire CV31 2JS Lead Inspector Deborah Shelton Unannounced Inspection 6th February 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Lawns Address 1 Gleave Road Whitnash Leamington Spa Warwickshire CV31 2JS 01926 425072 01926 831577 jillturley@warwickshire.gov.uk 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) Warwickshire County Council, Social Services Department Mrs Jill Turley Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That Mrs Jill Turley achieves NVQ level 4 in management and care including the Registered Managers Award, by June 2005. That Mrs Jill Turley notifies the Commission for Social Care Inspection upon successful completion of the above-mentioned award and immediately in the event of failure to achieve the award or cease, for whatever reason, to complete the award. 15th August 2005 Date of last inspection Brief Description of the Service: The Lawns is a care home providing personal care and accommodation for 35 older people. This includes a 5 bedded respite / short stay unit which is situated on the ground floor. Warwickshire County Council Social Service Department owns and manages the home. The home is in Whitnash on a housing estate, near to Leamington Spa. A local bus service, which circulates between Whitnash and Leamington Spa, stops near by. All bedrooms are single, 26 of which have en-suite facilities. A passenger lift enables access to all levels. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following are the findings of an unannounced inspection visit that took place between the hours of 10.30am and 7.55pm on Monday 6 February 2006. The manager was not available at this inspection as she was on sick leave. A Care Officer was on duty along with five care staff, two other care staff were also in attendance between the hours of 8am – 11am. Thirty-five people were living at The Lawns, five of these were staying for respite care. Six people were spoken to about their experiences of life at the Home. The inspection process also involved looking at paperwork, a tour of the building and discussions with staff on duty. Some of the documentation was looked at in the lounge, this enabled the inspector to see residents in their usual surroundings and see the interaction between staff and residents. What the service does well: What has improved since the last inspection? It was difficult to identify whether some of the issues identified at the last inspection visit had been addressed. Staff on duty at the time of the visit either did not have access to or where unaware of the location of certain pieces of documentary evidence. The manager was on sick leave and the inspection was carried out with the help of assistant managers. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 6 Some of the issues remain outstanding, as documentary or other evidence was not made available to demonstrate compliance to standards. 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. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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 The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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): 2 and 3 The contract does not give sufficient information to enable residents to be fully informed of the terms and conditions of the Home. Residents are fully assessed before admission enabling a plan of care to be developed to meet their individual needs. EVIDENCE: Three care files were reviewed to evidence whether each resident is provided with a contract. The Home has produced a “statement of resident’s rights and responsibilities” which is used as the contract/terms and conditions of residence. One of the three files contained a signed and dated document. The other two files contained a statement of residents’ rights and responsibilities, which had not been completed, dated or signed. It was a requirement of the last inspection of the Home that these documents must include individual information about cost and specific room numbers. This was not evident in two of the documents reviewed. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 9 Three files were reviewed to evidence that appropriate pre-admission assessments are completed. The admissions process includes obtaining a copy of the Assessment and Care Management Team’s (ACM) care plan provided by the social worker (if applicable). Once this documentation has been received an assessment is undertaken by staff from the Lawns. Standardised pre-admission assessment documentation is used when visiting potential residents. Relevant information is collected and a decision is made whether the resident’s needs can be met at the Home. Staff start to compile care plans once the decision has been made to admit the resident. Information obtained during the initial assessment is used to form care plans. A trial stay of four weeks is offered to new residents before agreeing to permanent residency. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 Care plans give comprehensive consideration to all aspects of health, personal and social care but do not contain enough information about the specific care required for individuals which puts residents at risk of not having their needs met. In general medication is well managed, occasional recording errors could put residents at risk of harm. Residents were treated with respect and their privacy and dignity were promoted enhancing their wellbeing and self esteem. EVIDENCE: Each resident has an individual plan of care. These are developed using preadmission assessment information. Three care files reviewed recorded details of residents’ health care needs. Guidelines to enable staff to meet these needs are brief and not specific on all occasions, for example: - The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 11 Medical “to monitor situation with diabetes”. No details of what staff are to do to “monitor the Situation”. “catheter in place, bags changed accordingly”. Accordingly? How often? “has regular accidents”. The action staff are to take to try and stop the “accidents” occurring is not recorded. “assistance required with oral health”. What type of assistance? Continence Continence Oral health Residents are at risk of not having their care needs met if plans do not contain enough detail. Standardised documentation used in care plans has space for the signature of resident’s or their representatives to demonstrate their involvement in the care planning process. None of the files seen had been signed. Staff had recorded in one file that the resident is unable to sign. Care plans seen had been reviewed in the months of December and January, however there was no evidence of regular monthly reviews prior to this. Manual handling assessments had not been fully completed. Bathing records were blank. Standardised documentation such as financial and legal arrangements, illness, dying and death and the statement of resident’s rights and responsibilities were blank. Staff had not dated and signed all information in files. The systems, storage and records regarding medication were reviewed. Medication administration records for one resident showed that on some occasions staff recorded R when the resident refused a painkiller, on other occasions staff left the records blank. It is therefore difficult to evidence whether the painkiller was actually offered to the resident. Controlled medications were reviewed, records were in good order and the stock of medication balanced with the number recorded in the controlled medication administration book. All staff that administer medication have received appropriate training. Staff were observed to have a good relationship with those under their care and were treating them with respect and maintaining dignity. Staff were seen knocking on bedroom doors and waiting to be invited in before entering. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 12 Residents were dressed appropriately for the time of year. One resident said that the laundry service is good, staff take away your clothes for laundering and bring them back the next day. This resident said that staff “can’t do enough for you, they are kind and helpful”. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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 The lifestyle experience in terms of social/leisure activities does not meet the expectations of all residents. This could result in poor self-esteem. Residents are able to receive visits from family and friends and staff ensure that visitors are made welcome. This improves resident’s sense of wellbeing. Documentary evidence to demonstrate that residents have choice and control over their lives is limited. Meals are well presented, wholesome and provide residents with a nutritious and balanced diet. EVIDENCE: There was limited documentary evidence to demonstrate that residents have a choice regarding the routines of daily living. Documentation in some care plans regarding religion was blank, also information regarding preferred times of rising and retiring was not available. The assistant manager said that staff are fully aware of residents preferences regarding routines of daily living. Staff apparently chat to residents to find out what they like and dislike, preferred times of rising and retiring and where they want to spend their day. There was no documentary evidence of this. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 14 Residents said that they are encouraged to make choices and to retain as much independence as possible. There was no activity programme available and limited evidence to demonstrate that activities take place. Bingo is held every fortnight and exercise to music once per week. Residents said that often there is nothing to do. During the tour of the premises residents in one lounge were either asleep or staring into space. One resident said that they do not like to watch the television but there is not a lot else to do. Another resident who chooses to spend most of the time in her bedroom said that staff are kind and call in to chat to her to see how she is doing. A week’s holiday is arranged each year. A resident said that she had enjoyed the holiday very much and also enjoyed day trips. A discussion was held regarding funding for these trips and the resident was under the impression that only those who could afford to pay for themselves were able to go. Staff were seen offering residents a choice of lunchtime meal and some residents said that there is always a choice. Residents spoken to who spend a large amount of time in their bedrooms were unaware that there is a choice of meal available. Residents meetings take place approximately every three months. The minutes of the last meeting held were on display on the notice board in the corridor. Visitors to the Home were seen to be made welcome by staff and were offered drinks. Residents said that visitors are always welcome and were invited to the Christmas party, which everyone enjoyed. A care assistant also stated that relatives were invited to eat their Christmas lunch at the Home. A separate dining area was set up for husbands, wives, sons and daughters etc and the resident. It was also noted that a local brownie and guide group preformed a carol service, which the resident’s enjoyed. Residents were given a choice of three meals at lunchtime. The inspector dined with residents and ate a meal of fish pie. Residents appeared to enjoy their meal. Staff were observed asking residents what they wanted for their meals the following day. Choices were available for breakfast, lunch and dinner. Staff did not rush residents to eat their meal, they were kind and patient. One resident required prompting, encouragement and occasional assistance to eat their meal. Staff handled this in a caring, sensitive manner. Two residents spoken to said that they do not always like the meals that are on offer. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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 Evidence of appropriate complaints practices was limited. Clear details of action taken following receipt of complaints were not available on all occasions. EVIDENCE: Social services comments, complaints and compliments forms are used to record any complaints received. Complaint details are kept in a logbook. One complaint from a resident had been handled in an appropriate manner and action taken to rectify the issue raised was recorded. Another complaint did not have any follow up action recorded, there was therefore no evidence that any action had been taken to address this complaint. The Commission for Social Care Inspection have not received any complaints about the Lawns since the last inspection. One resident said that staff encourage them to talk about any worries/concerns or needs that they might have so that they can help them. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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 Areas of décor in the Home are poorly maintained which does not provide a pleasant environment to live in. EVIDENCE: The Lawns is a purpose built care home located in a residential area close to the centre of Leamington Spa. A shaft lift gives access to all parts of the Home. Grab rails enable those with poor mobility to retain a level of independence whilst manoeuvring around the Home. Internally the Lawns is in need of maintenance, wallpaper is coming off walls or is marked and scraped. Areas such as dining rooms, lounges, corridors and bedrooms all require re-decoration. Doors and skirting boards were also marked. The carpet in the first floor dining room was heavily stained and in need of cleaning or replacing. The Home was clean and hygienic and no unpleasant odours were noted. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 17 Bedrooms were personalised with pictures and ornaments, which gave a homely, feel. Bedrooms seen did not contain furniture in line with the requirements of national minimum standards. Comfortable seating for two people is not available in all bedrooms and there is no table. Where a resident has said that they do not want furnishings in line with requirements or where the room size or layout would not allow, details must be recorded in the resident’s care file. Evidence must be available to demonstrate the reason why the required furnishings are not provided. The wardrobe door in one bedroom had fallen off and was awaiting repair. One resident said that she does not have net curtains and some dark evenings people in neighbouring flats/houses can see straight into her bedroom, which she does not like. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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): 29 Recruitment practices are not carried out thoroughly for all staff. EVIDENCE: Three staff files were examined. Not all contained the information required prior to employment of new staff. Copies of birth certificates were not available on each file seen neither were written references. Training certificates are available in staff files. The date of training on these certificates demonstrates that update training is required in some areas. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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): 35, 38 standards 31 and 33 were not assessed due to the managers absence Financial records were confusing and did not demonstrate that resident’s best interests are safeguarded. Updates in mandatory training are required for staff to safeguard the health, safety and well being of residents and staff. EVIDENCE: The registered manager was not on duty at the time of inspection as she was on sick leave. This standard could therefore not be assessed. Staff on duty were unsure about quality assurance documentation. No evidence of quality assurance systems was made available at the time of inspection. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 20 Resident’s spending money records were audited. The newspaper receipts for one resident were confusing, as amounts recorded did not correspond with the details recorded in the resident’s balance sheet. Staff are responsible for keeping these records up to date. The hairdresser does not issue receipts, this can also make records confusing. Another resident’s records showed a deduction by cheque for £150.00 there was no receipt or details regarding who the cheque was payable to or what has happened to the money. Various records were seen to evidence that the health and safety of residents and staff is maintained. Lift servicing records, hot water temperature checks, fire alarm and emergency light test records were some of the records seen. Staff on duty were unsure where all documentation regarding health and safety was kept. Documentation such as details of emergency light servicing, portable appliance testing and legionella tests were faxed the day after the inspection. These were all up to date. Limited evidence was available to demonstrate that mandatory training is up to date. The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 x 2 x x x x 2 x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 2 x x 2 The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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(1) Requirement The Registered Person must ensure care plans show clearly how each residents needs are to be met. They must contain sufficient detail to enable staff to complete the required action to meet the individual care needs of residents. (Outstanding since 31/02/05) 2 OP7 15(1)(2) The registered manager must ensure that all care plans are evaluated on a monthly basis. Evidence is required to demonstrate that care plans are drawn up with the involvement of the service user and/or their representative and to demonstrate their agreement to the care prescribed. An accurate record must be maintained of all medications, received and administered. 15/03/06 Timescale for action 15/03/06 3 OP7 15(1) 15/03/06 4 OP9 17(1)(a) 15/03/06 The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 23 5 OP12 12 (3) 16(2)(m)( n) The registered manager must 29/03/06 ensure that activities are organised to suit the individual needs of residents. Records must be maintained to demonstrate what activities have taken place and who has participated. The registered manager must ensure that evidence is available to demonstrate that residents have a choice regarding daily routines. Details regarding complaints received, investigation undertaken and outcome must completed and available for inspection. The registered provider must ensure that the Home is kept in good decorative order. (Outstanding since 01/02/04) 29/03/06 6 OP14 12(2)(3) 7 OP16 17(2) Sch 4 29/03/06 8 OP19 23 11/04/06 9 OP24 16(2)(c ) The Home must ensure that furnishings in accordance with National Minimum Standards are provided in bedrooms. Lockable furniture must be provided in all rooms. The Registered Person must carry out an audit of staff files to ensure documents and information required under regulations are maintained and available for inspection. (Outstanding since 31/01/05) 11/04/06 10 OP29 7, 9, 19 Sch 2 29/03/06 The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 24 11 OP35 17(2) Sch 4 The registered manager must ensure that receipts regarding resident’s personal expenditure balance with records held. The reason for withdrawal of funds must be recorded on each occasion. The Registered Person must ensure that training records are maintained and demonstrate that staff receive regular mandatory training. (Outstanding since15/08/05) 29/03/06 12 OP38 13(4)(5) 29/03/06 The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 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 OP2 Good Practice Recommendations The Registered Provider should review current contract to ensure it is in line with the National Minimum Standards i.e. includes payment amount and room number. Staff should be provided with opportunity to receive tissue viability and pressure area care training. The Home should explore the possibility of improving facilites for hearing and visualy impaired residents such as by installing a loop system. The Home should consider reviewing ancillary staffing levels at weekends. The Home should establish a programme to ensure that at least 50 of care staff have achieved NVQ 2 or equivalent. 2 3 OP8 OP22 4 5 OP27 OP28 The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 The Lawns DS0000041886.V281836.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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