Inspection on 25/07/06 for WCS - Sycamores, The

This inspection was carried out on 25th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

WCS - Sycamores, The 13/03/06

WCS - Sycamores, The 01/09/05

WCS - Sycamores, The 08/02/05

WCS - Sycamores, The 16/08/04

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 WCS - Sycamores, The Sydenham Drive Leamington Spa Warwickshire CV31 1PB Lead Inspector Sue Scully Key Unannounced Inspection 31 August 2007 10:00 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 WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCS - Sycamores, The Address Sydenham Drive Leamington Spa Warwickshire CV31 1PB 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) 01926 420964 01926 833591 admin@wcssycamores.f9.co.uk Warwickshire Care Services Limited Mrs Patrica Alleyne Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th March 2007 Brief Description of the Service: The home is situated the outskirts of Leamington Spa, within a housing estate and adjacent to an industrial estate. Close by is a small parade of shops, including a post office. The Sycamores care home is managed by Warwickshire Care Services. The Sycamores is registered as a care home providing personal care to 36 older people. On the ground floor of the premises there is accommodation for ten service users. The first and second floors can be accessed by means of a shaft lift or stairs and can accommodate a further 26 service users. Each floor has a lounge/diner, which have been extended and fitted with kitchenettes. On each floor there is also one bathroom and one shower room. Leamington Spa’s main shopping centre is within five-minute bus journey; the bus stop is directly outside the home. There is limited parking space for staff and visitors to the rear and side of the home. The fees for the home are £430 per week. There are additional charges for chiropody, the optician and dentist (depending on personal finances), newspapers, toiletries and hairdressing. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for the people who use the service and their views of the service provided, meaning they tell us if the home is meeting their needs, if the agency is flexible and suits their life style, and if the agency enables them to maintain their independence, preferences and choice of how they want to be supported. This process considers the home capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development The inspection was completed over one day by two inspectors. The home did not know that an inspection of the service was taking place. As part of the inspection process two people were case tracked this involves establishing individuals experiences of the service provided or observing practises of individual staff and how they have been trained to deliver a service that promotes the person well being and choices. We also discuss people’s care and look at care files focusing on outcomes for people. Case tracking can help us understand the experiences of people who use the service. In addition to this, information is looked at during the inspection such as polices and procedures, and the general operation of the agency in relation to meeting peoples needs. The home is also required to complete an annual quality assurance assessment (AQAA). The Commission sends this document to the provider before the inspection. The AQAA shows what the agency is doing well and if and what the agency could do better. The completion of the AQAA is a legal requirement that the provider must complete. The information gathered during the inspection process enables the Commission to build up a history of the service being provided and whether the service provided meets people needs and expectation. Information about the service can also be obtained from CSCI web site at www.csci.org.uk Where you can obtain copies of recent inspection reports. What the service does well: The home collects good information before people are admitted into the home and this means needs can be identified and plans put into place to meet these needs. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 6 The home’s administration of medication was good and this good standard had been maintained for over six months. This makes sure residents receive their prescribed medication safely. Peoples personal hygiene needs appeared to have been attended to and residents appeared well cared for. People who use the service had choices about what they wished to do each day such as going out or particiaopteing in activities. The menus were varied and detailed snacks that were available. People spoken with said the food was good and they were given a choice of what they wanted. The home is purpose built and structurally enables the people who live there to have space to walk, and is suitable for disabled people that need equipment for their condition. The home had aids available to assist people to bathe and to use the toilet safely and this ensures that their personal hygiene is maintained. The home was clean and fresh on the day of the inspection, providing a homely environment for residents to live in. What has improved since the last inspection? What they could do better: There are still some areas in care plans that need further development to include information about past life history to make each care plan more individualised and build on the persons strength. This will mean the information gathered about each person will create their personal identity how they can be supported to make choices and decisions of how they want to be cared for while staying at the home. Activity records need to show how each person has been given the opportunity to continue with a wide range of activities, particular activities they have been familiar with in the past. This will reflect their choices and opportunity of taking up new activities. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 7 Risk assessments need to be further developed to ensure all risks are known and managed to reduce the risk further, so people are safe. More attention to detail in daily records to show how the care is delivered daily as agreed in peoples care plans will ensure all needs are met. Entries such as all food eaten and all personal care given do not show how choices and people personal preferences are supported. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need to make choices whether or not they want to live in the home. A full assessment is undertaken before the person moves into the home to ensure the home is able to meet their needs. EVIDENCE: The statement of purpose and service users guide has good information about the service provided, what facilities there are and how the home will meet the person needs as individual people. The information includes the qualifications of the staff team, so people can be assured that experiences qualified staff will be looking after them. Full details and history of the provider, the aims and objective of the service and the range of needs of the people who would be able to move into the home. The information provided enables people to make their own decisions if the home is suitable for them. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 10 Pre admission assessments were thorough and contained good information about the needs of the people who use the service. This information was then transferred into care plans so staff would be able to meet their needs and care for them safely. At all stages of the assessment there was full consultation with the person moving into the home about the facilities available and how best the home could ensure the persons needs would be met. Intermediate care is not provided at the home. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Medication management ensures people are administered their medication safely. Staff have detailed information in care plans to support people in the way they choose. EVIDENCE: The care plans for three people were sampled; there was good information about each person of how they want their needs to be met and how this would be achieved. Care plans were up to date and very detailed so staff would know how to support each person safely. Care plans do not always cross reference to daily records to show that the person needs are being met. For example the information recorded in four daily records that were sampled the staff had wrote “all care given’’, “ washed and eaten well’’ “ no problems today’’. It was particular important to record WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 12 significant information about what these people had eaten to maintain their health, so entries such as eaten well would not give the information to staff to ensure the person was receiving a well balanced diet. The acting manager said each person has a food-monitoring chart where this information is recorded, however when the inspector sampled these food charts there were significant gaps where staff had not recorded this information. Attention to detail in daily records is required to ensure that significant information is recorded to protect people health and wellbeing and ensure or people needs are met daily. Reviews of the person care is completed regular to identify any changing needs the person may have. It is also good that reviews are held with each person annually, this enables the person to express their choices and preferences and what is important to them. Family and other representatives are invited to express their views about the service and how they feel the person has settled in to the home. Medication records showed regular reviews with the person’s general practitioner to ensure people were not taking medication unnecessarily. Medication systems ensure people are administered medication safely by staff that have been trained in the safe handling and administration of medication. People who use the service were spoken with and said the home was nice and staff were nice. Observation during the visit showed staff were respectful and interacted well with the people who live in the home. Where possible the people are supported to self-administer their own medication and systems are in place to ensure they do this safely by regular consultation with each person. The manager completes regular audits of all medication that has been received into the home, including audits for people who self administer their own medication. Copies of prescriptions are retained so staff can check the correct medication has been received from the chemist. Where people are administered prescribe medication (PRN) as required, a protocol is in place stating when and why the medication was given or taken so staff can monitor if the medication is needed regularly and consult other healthcare professionals if required to ensure there is not a health problem occurring. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adeqaute. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that the people living in the home experience a meaningful lifestyle. People are offered a healthy diet and enjoy their meals. EVIDENCE: Observation of practice showed that there is a staff team whose members originate from a wide range of ethnic origin, who would have the knowledge necessary to meet the needs of people from differing ethnic origin. English is not the first language of some staff, however they were consistent in their interactions ensuring that they spoke clearly and repeated if necessary in order to help service users understand them. Staff training records indicated that some had the training necessary to meet the diverse needs of service users, this included training in Health and Safety, Manual Handling, some Dementia care, and 70 had NVQ level 2. The home has open visiting arrangements and people who use the service confirmed they entertain their family and friends in their own room, or use the communal lounge. A relative said, ’The staff are very pleasant, when we visit they are friendly and offer tea or coffee ‘. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 14 Another relative said ‘I can’t fault the care staff they do a good job, always in clean clothes and well groomed, they manage the continence well, but I don’t really know the people in the office, it’s difficult to get to know people and I’ve never been involved in a care plan meeting, and didn’t know there were inspection reports we could read.’ Some people who live in the home went out with their relatives but there were no regular outings organised by the home at present. The manger had implemented a planned activity programme so people could join in if they wished. Activity records needed to include comments on who had taken part, who had refused and whether it had been enjoyed to ensure activities were of people choices and past experiences. Church services were held in the home however people had the choice to go out to church if they wished. Relative and visitors were welcome at any time and there were no restriction. There was evidence that there were some newspapers delivered to the home. Some people spoken with said ‘there was not much going on’ and ‘they tend to watch the television’. The home has recognised there needs to be improvement in the areas of activities so people lead a fulfilled life The people who use the service said they enjoyed the food and there was plenty of it available. The menu showed a well balanced diet was available with an alternative choice of food available if people did not like what was on the menu. There were clear instructions for staff to ensure the people who was diabetic or had a soft diet their dietary needs would be met. One relative said the soft diet was normally separated such as portions of meat, potatoes and vegetables, they were all kept separated when served so the meal looked more appealing. Aids such as special cutlery were available for people who had difficulty holding normal cutlery were available to enable them to be independent. Food stocks appeared to be satisfactory. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home know how to make a complaint and can be confident that their views will be listened to and acted on. Arrangements are sufficient to ensure that people are cared for safely and protected from abuse, neglect or harm. EVIDENCE: There are procedures in place to investigate all complaints or concerns. People are issued with a copy of the complaints procedure on admission and a further copy is on display within the home. Since the last inspection two verbal complaints were made and these were dealt with appropriately. Reviews with each person are undertaken regularly where concerns can be raised and action taken quickly, this ensures people have access to different sources to make a complaint if the wish. It is recommended the complaint procedure be available in different formats based on individual needs of people living in the home, such as pictorial, written, audio, symbols, so people have access to the complaints procedure and know how to complain if they feel they have any concerns. There had been no complaints from the people who use the service received at the Commission for Social Care Inspection (CSCI) since the last inspection. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 16 It was positive to note that complaints are also audited via the monthly regulation 26 visits. This will further enhance the protection of the people who use the service. The home had received one complaint from a number of relatives. A meeting had been arranged to discuss issues raised in the letter received. It is requested the manager forward the outcome of the meeting to the commission for social care inspection (CSCI) once concluded. There has been progress on producing and implementing an Adult Protection Policy and Procedure; this includes a Whistle Blowing Policy so people are able to report incidents if they occur so people who use the service are protected form harm. Care plan and risk assessments have detailed information of how to support people safely ensuing people are protected from injury or harm. The home has a written policy that covers all relevant aspects of adult protection, which is complimented by the No Secrets document issued by the Department of Health. The home has a rolling programme of staff training in respect of adult protection that ensure people are looked after safely. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a warm and comfortable secure accommodation to promote their well-being. EVIDENCE: The home provides a comfortable, spacious accommodation that is clean and decorated to a good standard and accommodates people with physical disabilities with various aids and adaptations as required. Aids and adaptation are provided based on each person needs. Bedrooms seen during the visit were personal to the individual with pictures and photo of family and friends and they reflected the person age, gender, and culture. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from staff who are trained to meet their individual needs and care for them safely. Recruitment practices are robust and therefore protect people from harm. EVIDENCE: Observation of practice showed that there is a staff team whose members originate from a wide range of ethnic origin, who would have the knowledge necessary to meet the needs of people from differing ethnic origin. English is not the first language of some staff, however they were consistent in their interactions ensuring that they spoke clearly and repeated if necessary in order to help service users understand them. Staff training records indicated that some had the training necessary to meet the diverse needs of service users, this included training in Health and Safety, Manual Handling, some Dementia care, and 70 had NVQ level 2. The three staff files examined revealed that all necessary checks are carried out before employment is commenced, such as references, application forms, medical clearance previous employment history, education and experiences. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 19 POVA checks (Protection of Vulnerable Adults), CRB (criminal Records Checks) are completed to ensure the people who use the service are safe from harm. The staff have regular meeting to discuss issues that may effect the running of the home, peoples needs, such as risk assessments, care plans, complaints, how staff can improve the service further. Ideas and suggestion are shared with the people living in the home for their views. The number of staff on duty at the time of the inspection was satisfactory to enable people to access the community and receive the level of support and supervision required safely. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has good vision for the development of the home and staff have clear lines of accountability. The Health and Safety arrangements ensure that residents are protected from harm and live safely in a home that is well run. EVIDENCE: Records sampled showed all aspects of health and safety issues including checks and servicing of equipment are valid. Fire alarms and emergency lighting are tested regularly and the results recorded. Fire safety training and WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 21 fire drills are carried regularly. Storage of COSHH items were found to be appropriate. Safety is considered to be a paramount matter. The Home’s Management team and external Managers ensure that good standards are maintained with the Home being run in the best interests of the people who live in the home by completing regular audits of comments received from relatives, regular meetings with relatives and healthcare professionals. The systems for resident and staff consultation are good and this ensures that any suggestions about the service provided are put forward. There are systems in place to monitor the quality of service on offer to the residents. The system for the safekeeping of residents’ personal allowances is robust. Maintenance checks of equipment used at the Home are undertaken to ensure that they are safe to use and staff receive the appropriate training regarding health and safety issues to ensure that they work in a safe manner. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 23 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 Daily records should be linked to care plans and demonstrate the actions that staff are taking to deliver the prescribed care. Timescale for action 01/10/07 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 OP1 Good Practice Recommendations It is recommended that information be provided in different formats based on the person needs, such as large print, audio, to ensure people with nay disabilities have access to information about the service provided. WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI WCS - Sycamores, The DS0000004269.V345543.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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