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Inspection on 04/10/05 for Whiteley Village Care Centre

Also see our care home review for Whiteley Village Care Centre for more information

This inspection was carried out on 4th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home was open, relaxed and friendly. The service holds residents and relatives meetings on a regular basis. There is a quality assurance system in place, which is based on gaining feedback from residents and relatives. Some residents are involved in a committee looking at the quality of meals. A meeting was arranged for relatives with the infection of control nurse to provide them with information. There is a structured activities timetable in place and comments received from residents indicate that are happy with the service provided. A number of residents and friends were seen enjoying a show which was being held and which everybody was clearly enjoying. It was pleasing to see care staff being involved in the entertainment. The home has completed detailed care plans and risk assessments and evidence was seen that residents are provided a copy of their plan. A majority of the comments received from residents indicate that they feel they are well cared for. One resident spoken stated, "I am very happy and the carers are excellent". Other comments received included "Marvellous". "The staff are exceptionally good, they go out of their way to make sure everything is fine". "I cannot speak to highly of the care, kindness, consideration and comfort I have received". From the comments received by relatives they were all satisfied with the care that their relative is receiving and that they are kept informed of important matters relating to their relative and are made to feel welcome when they visit. One relative stated," This is a wonderful nursing home and the staff are so helpful and kind". The home provides a good standard of staff training with a training coordinator in post and records indicate that training is updated. Staff spoken to confirm that they receive regular supervision sessions from their manager/ supervisor. All staff spoken to were enthusiastic and were enjoying working in the home. Good communication was seen between staff members.

What has improved since the last inspection?

The home has implemented a quality assurance system to obtain feedback, which extended to relatives. The Manager obtained an updated copy of the Local Authority Protection of Vulnerable Adults procedure.

CARE HOMES FOR OLDER PEOPLE Whiteley Village Care Centre Whiteley Village Care Centre Whiteley Village Walton On Thames Surrey KT12 4EH Lead Inspector Lisa Johnson Announced Inspection 4th October 2005 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 Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Whiteley Village Care Centre Address Whiteley Village Care Centre Whiteley Village Walton On Thames Surrey KT12 4EH 01932 857821 01932 825843 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) The Whiteley Homes Trust Mrs Nancy Hunter Care Home 114 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (114) of places Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to 58 beds providing nursing care for older people from the age of 60 years Of the 114 older people accommodated, Up to 4 may be in the category DE(E), older people suffering from dementia 20th June 2005 Date of last inspection Brief Description of the Service: Whiteley Care Centre is located in Whiteley Village near Walton on Thames, Surrey. The village and care services are owned and operated by the charitable homes Whiteley Homes Trust. The village is selfcontained with amenities, sports and social activities provided on site. Whiteley house provides personal support and nursing care which is provided on the ground and first floor. The Care Centre also provides personal support to 28 people in Ingram house which is based next to the main building. Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes second inspection carried out in 2005/2006.The announced inspection took place over six hours and was carried out by three inspectors. The main focus of the inspection was to review to requirements made at the last inspection. A tour of the premises took place including the nursing wing, residential wing and Ingram house. Care plans, staff files and policies and procedures were sampled. The inspector spoke to ten residents, one relative and a number of staff in the home. Thirty-two comment cards were also received from residents seven were received from relatives/friends and three were received from healthcare professionals. These comments are reflected in the report. The inspectors would like to thank the residents, relatives and staff for their cooperation during this inspection. What the service does well: The home was open, relaxed and friendly. The service holds residents and relatives meetings on a regular basis. There is a quality assurance system in place, which is based on gaining feedback from residents and relatives. Some residents are involved in a committee looking at the quality of meals. A meeting was arranged for relatives with the infection of control nurse to provide them with information. There is a structured activities timetable in place and comments received from residents indicate that are happy with the service provided. A number of residents and friends were seen enjoying a show which was being held and which everybody was clearly enjoying. It was pleasing to see care staff being involved in the entertainment. The home has completed detailed care plans and risk assessments and evidence was seen that residents are provided a copy of their plan. A majority of the comments received from residents indicate that they feel they are well cared for. One resident spoken stated, “I am very happy and the carers are excellent”. Other comments received included “Marvellous”. “The staff are exceptionally good, they go out of their way to make sure everything is fine”. “I cannot speak to highly of the care, kindness, consideration and comfort I have received”. From the comments received by relatives they were all satisfied with the care that their relative is receiving and that they are kept informed of important Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 6 matters relating to their relative and are made to feel welcome when they visit. One relative stated,” This is a wonderful nursing home and the staff are so helpful and kind”. The home provides a good standard of staff training with a training coordinator in post and records indicate that training is updated. Staff spoken to confirm that they receive regular supervision sessions from their manager/ supervisor. All staff spoken to were enthusiastic and were enjoying working in the home. Good communication was seen between staff members. What has improved since the last inspection? What they could do better: Some of the bedroom doors were found wedged open and a requirement was made that this practice is risked assessed to ensure the heath and safety of residents and staff is protected in the event of a fire. The registered manager has since contacted the fire officer to arrange a visit to the home and the outcome and recommendations of this visit should be made available to the commission for Social Care Inspection. A cupboard was found unlocked containing hazardous substances in one of the sluice rooms. An immediate requirement was made that this cupboard is locked at all times to protect the health and safety of residents. Some concerns were raised from residents that there had been changes to the times that they received their medication either being administered to early in the morning or late at night. A requirement was made that this addressed to ensure that individual’s preferences are respected. A recommendation was made that photographs of residents are included with the medication and administration records. A requirement was made that the cleanliness of one sluice room is addressed as some of the commode pans were dirty and there was a malodour. This is to ensure that the home is clean and hygienic. There are adequate policies and procedures in place in respect of infection of control. However a Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 7 recommendation was made that advice is sort from the infection of control nurse in relation to the suitability of the soap provided in the toilets for hand washing in the residential wing. 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. Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 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 Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 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 the following standard(s): 6 Each resident is provided with written contract/statement terms and conditions with the home. EVIDENCE: Resident’s contracts were sampled and of the residents were issued with a contract in the form of a statement of terms and conditions. The resident and/or representative signed contracts where possible. Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &11 The home demonstrated that detailed individual care plans were in place that meets the health and personal care needs of residents. Residents were protected by the homes policies and procedures for dealing with medicines but needs to review the times of medication administration. The home is able to demonstrate that the individual’s wishes concerning illness and death are recorded on individual’s plans. EVIDENCE: A key nurse system is implemented and Individual cares plans are completed which are are signed by individuals and a copy is maintained by them, which were seen in bedrooms. Plans were sampled and were detailed and comprehensive ensuring that individuals health, personal and social needs were set out. Water low and nutritional assessments were in place and MRSA guidelines were in place where necessary and charts were accurately recorded. Detailed risk plans were in place including moving and handling, use of bedrails, smoking and self-medication. A requirement was made that all care plans are signed by staff that has completed the plan and that dates are recorded on risk assessments when they have been updated, as there were Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 11 some gaps. A recommendation was made that the service should consider reviewing the quality of copying forms. Comments received from visiting healthcare professionals reflect that the home works in partnership with them and that they are able to visit residents in private. The medication records were sampled and were maintained adeqequately and stored appropriately. Some residents in the residential wing had raised concerns that times of medication administration had been changed either being administered to early in the morning or to late at night. One resident stated that she was receiving medication at six thirty in the morning. On checking the medication record there was no prescription for medication at this time. A requirement was made that the home reviews the administration times of medication. A recommendation was made that the home should consider including photographs with the medication and administration records. It was clear that resident’s wishes about what they wish to happen when death approaches has been discussed and that this was recorded in individual plans. Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 12 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 & 15 The home is able to demonstrate that residents have access to a range Recreational and leisure activities. Residents are encouraged to maintain control and make choices but individual preferred times of receiving medication must be actioned. Residents are provided with a well balanced diet. EVIDENCE: There is an activities coordinator in post and a timetable is displayed. Comments received from residents indicate that they were generally satisfied with the range of recreational and leisure activities provided. A concert was observed and many residents were present with some of their relatives. It was pleasing to see staff participating in the entertainment and it was clear that everybody was enjoying the show. Comments received from relatives/friends indicate that are made to feel welcome when they visit and that they are able visit their relative in private. It was evident that residents were able to bring their personal belongings in the home by the range of items on seen on display in individual bedrooms. Residents are offered choices of meals and preferences for having meals in their rooms was accommodated. However some residents in the residential unit raised concerns in respect of time changes that had been made in receiving medication either to early in the morning or late at night. A Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 13 requirement was made that this practice is reviewed to ensure that individual’s preferences and choices are respected. The lunchtime meal was of a good standard and was nutritious and there were four choices. Variable views were received from residents in respect of meals, however it was clear that the registered manager is responding to individual’s views with a food committee in place and a new catering manager is in post who wishes to make further improvements and involve residents in the process. Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 14 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): 16,17 & 18 The home is able to demonstrate that it has an accessible complaints procedure in place. Policies and procedures were in place that ensures that residents are protected from abuse. EVIDENCE: There is an accessible complaints procedure in place. The registered manager maintains a record of complaints received and responds within the agreed timescales Two residents spoken to confirmed that they have received the complaints procedure and all comment cards received demonstrate that residents would know who to approach if they were unhappy about any aspects of their care and some relatives were also aware of the complaints procedure. There is a resident’s charter in place. Policies and procedures were in place for the protection of vulnerable adults and procedures and these was displayed throughout the home and evidence was seen that staff receive training in the protection of vulnerable adults. Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 15 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, 20, 22, 23, 24, 25 & 26 Individuals live in a comfortable and well-maintained home. Residents have spacious bedrooms that are comfortable and promote individual tastes and interests. The home provides specialist equipment to maximise resident’s independence. The home was clean and hygienic, however the cleanliness of one sluice must be attended to. EVIDENCE: The home was well maintained in good decorative order and adequately furnished. The grounds are pleasant and well maintained. The home provides a range of specialist equipment to ensure that residents independence is maximised including assisted baths, grab rails, seat raisers, hoists, pressure relieving mattresses, cushions and nurse-call bells. Bedrooms were spacious and comfortable. Residents were able to bring in their own possessions in to the home, which were on display. The cleanliness of the home was maintained to a good standard. Bedrooms Were clean and bright with no pervading odours. However a requirement was made that the cleanliness of one sluice room requires addressing, as there was a malodour and commode pans that were not cleaned sufficiently. The Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 16 manager stated that new washers are on order. Adequate policies and procedures were in place with respect to infection of control and ample hand washing and facilities were in place. Reviews of the procedures in the home are undertaken by an infection of control nurse. A recommendation was made that the registered manager consults the infection of control nurse with respect to the suitability of the hand washing soap provided in the residential wing Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 &30 The staffing levels in the home were adequate to meet the needs of residents. Staff are provided appropriate training to carry out their job competently, which ensures that residents are in safe hands. EVIDENCE: The duty rotas were sampled and appropriate levels of staff were available. There are seven care staff vacancies. Some agency cover is utilized. There is a training coordinator in post and evidence of a good training programme in place for staff that includes mandatory training, TOPPS induction and foundation courses and first aid. Some staff have completed supervision courses and record keeping. Other courses completed include bereavement, wound management; continence, venepuncture and distance learning courses have been completed. Fifty-four staff have completed National Vocational Qualifications in levels one and two and fourteen other staff are also currently undertaking National Vocational Qualifications Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 18 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): The registered manager has implemented a quality assurance system based on seeking the views of residents and relatives. Residents are safeguarded by the financial procedures in the home. Records were adequately maintained and kept secure. The registered manager has implemented adequate policies and procedures to ensure the but must ensure that fire procedures and the storing of hazardous materials is adhered to protect the health, welfare and safety of residents. EVIDENCE: A quality assurance system is in place, which is based on a feedback questionnaire for residents and staff. The manager is currently analyzing outcomes from a survey which she intends to feedback the outcomes to residents and relatives. Posters were seen on the notice board informing Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 19 everybody that the Commission was undertaking an announced inspection for Social Care Inspection and a number of residents spoken to confirm that they were aware of the inspection visit. A range of comprehensive policies and procedures has been completed and were sampled. It was clear that staff are made aware of any new policies, which the manager stated are discussed at staff meetings and are signed by staff. Policies sampled included recruitment, training and induction, disciplinary and grievance, code of conduct, residents monies, data protection and equal opportunities. A number of nursing procedures were sampled including medication, bathing, and peg feeding and accident procedures. Accident records were sampled and maintained appropriately. A business plan was in place, which outlines the budget, and service development plans. Appropriate Insurance cover is in place. Some small amounts of monies belonging to residents are maintained by the home. Records were sampled and were adequately recorded with clear evidence of purchases and receipts in place. Records were stored securely with adequate systems in place. Policies and procedures were completed and sampled for health and safety, infection control, disposal of clinical waste, manual handling, infectious diseases, MRSA , COSHH and fire procedures. PACT testing is completed, servicing certificates for hoists were available and emergency lighting and water checks were all recorded. However some bedroom doors were found wedged open and a requirement was made that this practice is risk assessed with advise gained from the fire officer. A cupboard containing hazardous substances was found unlocked in one sluice room and an immediate requirement was made that this is locked at all times to protect the health, welfare and safety of residents. Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 20 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 X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X 3 3 3 X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 3 3 3 3 2 Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP 7 Regulation 15(a) Requirement The registered manager must ensure that all care plans are signed and dated by the staff member completing the plan and including risk assessments. This is to ensure that each resident has an up to date plan that sets out the health, personal and social needs of individuals. The registered manager must ensure that the times of medication administration for individuals living in the residential wing is reviewed to ensure that the choice and preferences of individuals as to what time they prefer their medication is respected The sluice facilities and cleanliness must be addressed in one sluice room. Arrangements must be made for risk assessments to be carried out in respect of the use of door wedges in bedroom doors. This is to include the recommendation from the fire officer and the outcome is to be made available to the Commission for Social Care inspection. The cupboards containing DS0000017658.V251980.R01.S.doc Timescale for action 04/12/05 2 OP9 OP 14 13(2) 12 (d) 04/11/05 3 4 OP26 OP38 23(2)(d) 23(4)(a) (I) 04/11/05 21/10/05 5 OP38 13(4)(a) 04/10/05 Page 22 Whiteley Village Care Centre Version 5.0 (c) cleaning materials must be locked at all times to protect the health and safety of residents. 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 OP7 OP9 OP 38 Good Practice Recommendations The home should consider reviewing the quality of some of the copied forms on individual files. The home should consider including photographs of individuals with the medication and administration records. The home should consider obtaining advice from the infection control nurse in respect of the hand washing soap in the toilets in the residential wing. Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Whiteley Village Care Centre DS0000017658.V251980.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!