Inspection on 06/11/06 for Woodstock

This inspection was carried out on 6th November 2006.

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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodstock 30/09/08

Woodstock 05/01/05

Woodstock 28/11/04

Woodstock 18/05/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Woodstock 186 White Lion Road Little Chalfont Amersham Bucks HP7 9NR Lead Inspector Chris Schwarz Unannounced Inspection 6 & 23 November 2006 2:00 th rd Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 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 Woodstock DS0000023037.V311019.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 Adults 18-65. 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. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodstock Address 186 White Lion Road Little Chalfont Amersham Bucks HP7 9NR 01494 765401 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) admin@fremantletrust.org The Fremantle Trust Mrs Linda Perkins Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th April 2005 Brief Description of the Service: Woodstock is a large detached property located in Little Chalfont. The home is close to local shops and is accessible by public transport. It is owned and staffed by The Fremantle Trust and registered to provide accommodation for up to eight people with learning disabilities. There is a large enclosed garden at the rear and a front garden with parking spaces. Each service user has a single bedroom, two of which are on the ground floor. The home has been arranged to reflect a large family type environment and is indistinguishable in the road as a care home. The people living at Woodstock have varying care needs, some of which are complex. Current fees for the service were £660.52 per week, according to information supplied in pre-inspection documents. Additional charges are made for personal items, such as toiletries, sundries and outings. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of two half days and covered all of the key standards for younger adults. The first visit was unannounced, providing opportunity to see service users when they returned from day services, and speak with staff. The second visit was then pre-arranged to meet with the manager, to focus on recruitment practice and clarify any issues arising from the first visit. The inspection process paid particular attention to how the home meets service users’ needs, especially those arising from equality and diversity. Prior to the visit, a questionnaire was sent to the manager alongside comment cards for distribution to service users, relatives and visiting professionals. Any replies that were received from the comment cards have helped to form judgments about standards of care at the home. The inspection overall consisted of discussion with the manager and individual meetings with some of the staff team. There were opportunities to observe care practice and to meet with service users to gain their views. A tour of the premises and examination of some of the required records was also undertaken. At the end of the inspection, feedback was given to the registered manager. Staff and service users are thanked for their co-operation and hospitality during both visits. What the service does well: Needs arising from equality and diversity are well met, ensuring that each persons individual circumstances are taken into account. The needs of prospective service users are thoroughly assessed prior to admission, ensuring that the service does not offer a placement to people whose needs it cannot meet. Care plans have been produced for all service users, ensuring that needs have been identified and can be met. Service users are enabled to make decisions and be as independent as possible, providing them with choice and involvement. Service users are enabled to take responsible risks, ensuring that their independence is promoted. Service users take part in appropriate activities and make use of the local facilities, providing stimulation and variety. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 6 Service users are enabled to keep in contact with friends and family, maintaining important social links. The rights of the individual are respected, promoting fulfilment and affording service users respect. Meals are appropriately managed to ensure that service users receive the nutrients they require to keep them healthy. Personal support needs are recorded in care plans to ensure that service users receive the assistance they require. Physical and emotional health care needs are well managed to ensure that service users keep well. Medication practice is safe and ensures that service users receive the medicines they require. Effective complaints procedures are in place to listen to the views of service users and their representatives. Adult protection is well managed with appropriate policies, procedures and staff training in place to reduce the risk of harm to service users. A clean, comfortable and homely environment has been created for service users, ensuring that they have appropriate surroundings in which to live. Competent and qualified staff work at the home, ensuring that service users are cared for by people with the skills and knowledge necessary to meet their needs. Thorough recruitment practices are undertaken, to ensure that service users are protected from unscrupulous persons working with them. Training is undertaken by staff to ensure they are equipped to meet the needs of service users. The home is managed by a competent and qualified person, ensuring continuity of care and that needs are met. There is effective monitoring by the provider to ensure that standards of care meet the needs of service users. Health and safety is well managed, ensuring that staff, service users and visitors are not placed at risk of harm. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The needs of prospective service users are thoroughly assessed prior to admission, ensuring that the service does not offer a placement to people whose needs it cannot meet. EVIDENCE: There had not been any new admissions to Woodstock since the previous inspection. Care files showed that existing service users’ needs had been adequately assessed with supporting documentation from Social Services. Copies of the statement of purpose and service users guide were available in the home as were copies of contracts. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care plans have been produced for all service users, ensuring that needs have been identified and can be met. Service users are enabled to make decisions and be as independent as possible, providing them with choice and involvement. Service users are enabled to take responsible risks, ensuring that their independence is promoted. Evidence of risks being reviewed is needed, to ensure that service users remain safe. EVIDENCE: Care plans were in place for each person, outlining their physical, social and emotional needs. Documents were signed and dated and provided a good reference for staff. Guidelines were in place for managing inappropriate behaviour and there were good descriptions of seizures and action to be taken. There was evidence of recent and planned reviews taking place to evaluate care needs. Risk assessments were in place for a range of daily living tasks Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 11 and it was noted that moving and handling assessments had been reviewed as required at the last inspection. It was not evident that other risk assessments were subject to at least annual reviewing and this should become part of practice at the home, to ensure that service users remain safe. A requirement is made to address this. The home manages the money of service users with records kept of each transaction and receipts to explain expenditure. Records are well kept by the home’s administrator. Service users will benefit financially as a result of movement of the majority of their savings into interest bearing accounts, arranged in conjunction with the provider and legal advice. Service users were observed being asked to make choices, such as which sort of drink they would like and consulted about the evening meal. They were free to move around the building and watch their meal being prepared. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users take part in appropriate activities and make use of the local facilities, providing stimulation and variety. Service users are enabled to keep in contact with friends and family, maintaining important social links. The rights of the individual are respected, promoting fulfilment and affording service users respect. Meals are appropriately managed to ensure that service users receive the nutrients they require to keep them healthy. EVIDENCE: Service users attend day services during the week and records on care plans showed that the home and day services liaise to discuss individuals and contribute to reviews. A holiday to Butlins earlier in the year had been Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 13 successful and was enjoyed by service users and there were plenty of photographs to support this. Records in daily notes showed that use is made of local shops, pubs and facilities and one person mentioned that she still goes to Gateway Club. Daily notes and discussions with staff and service users showed that service users remain in contact with family and friends and visitors to the home are made welcome. Some service users regularly stay with their families and this is an important aspect of their care. Routines within the home were seen to be flexible with staff responding to service users as soon as they returned to the home, taking off coats, offering drinks and carrying out personal care in private as and when service users required it. One service user who wanted to eat early was enabled to do so and staff had prepared a meal to match his food likes, which were different to the meal being prepared for other service users. The dining area was well presented and service users enjoyed their meal at a leisurely pace. Records showed that varied meals are being provided at the home and the fridge was well stocked and there was plenty of fresh fruit around. Dates of opening had been written on opened packs in the fridge to ensure that only fresh produce was used. The only issue raised during the inspection was the siting of a small fridge in the laundry. It is recommended that the approval of an environmental health officer be sought to ensure that this is hygienic. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Personal support needs are recorded in care plans to ensure that service users receive the assistance they require. Physical and emotional health care needs are well managed to ensure that service users keep well. Medication practice is generally safe and ensures that service users receive the medicines they require. EVIDENCE: Any assistance required with personal care needs was well documented in care plan files. There was evidence from correspondence of involvement with other agencies, such as the National Society for Epilepsy and the consultant psychiatrist specialising in learning disabilities. It was good to see a letter from a health care professional on file which commented that a service user’s epilepsy was better controlled. Records of routine health care appointments were being maintained, providing an at a glance look at health issues or any follow up action needed. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 15 Medication was being managed by staff using a monitored dose system. A photograph of each service user was in place to readily identify the right recipient of medicines and medication administration records were in good order. It was noted that a medicine that requires administration before tea time was given at the correct time and recorded as such. Discussion with staff was helpful in understanding current care needs. Staff were professional in their dialogue and demonstrated awareness of service users’ disabilities and their individual circumstances, with some valuable insight shown. The medication policy contained within the home was dated 1999 with additional interim guidelines dated 2003. It is recommended that the manager check with her organisation that she has the most up-to-date version available in the home. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Effective complaints procedures are in place to listen to the views of service users and their representatives. Verbal concerns should be recorded, to reflect openness. Adult protection is well managed with appropriate policies, procedures and staff training in place to reduce the risk of harm to service users. EVIDENCE: The home has a complaints procedure in place and a pictorial version is also available. A log of complaints is in place although a complaint indicated in the pre-inspection questionnaire was not recorded. In discussion with the manager, the matter was not a formal complaint but a verbal concern made by a relative. It is recommended that such concerns be noted in the log book, to show that staff listened, passed the issue to the manager and that it was dealt with appropriately. The Commission is not aware of service users or their representatives making any complaints about this service. There are Protection of Vulnerable Adults and whistle blowing procedures in place at Woodstock and it was seen that the provider has produced a new training pack on abuse awareness which has been undertaken by some of the staff team. Other staff have undertaken training as part of their induction or National Vocational Qualification level 2. Awareness raising for service users has been taking place to help reduce their vulnerability. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 17 The home responded appropriately to an adult protection issue occurring in another setting and put the service user’s health and welfare first in dealing with this. The Commission has not been made aware of any other adult protection matters since the last inspection. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A clean, comfortable and homely environment has been created for service users, ensuring that they have appropriate surroundings in which to live. EVIDENCE: Woodstock is a large detached property located in Little Chalfont. The home is close to local shops and is accessible by public transport. There is a large enclosed garden at the rear and a front garden with parking spaces. Each service user has a single bedroom, two of which are on the ground floor. At this inspection it was possible to see that further redecoration has taken place around the premises plus new curtains and light shades in communal areas. All areas of the home were clean and bathrooms and toilets stocked with soap, hand towels and toilet roll. Appropriate arrangements were in place for the disposal of clinical waste and there were no odours around the building. Positive changes had been made to the downstairs bathroom to refurbish the room to best meet service users’ needs. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Competent and qualified staff work at the home, ensuring that service users are cared for by people with the skills and knowledge necessary to meet their needs. Thorough recruitment practices are undertaken, to ensure that service users are protected from unscrupulous persons working with them. Training is undertaken by staff to ensure they are equipped to meet the needs of service users. EVIDENCE: Rotas showed that sufficient numbers of staff are on duty to meet service users’ needs and this was apparent also from observation of practice at the home. Staff interacted with service users in positive, calm and attentive manners and were professional in discussions during the inspection. One relative commented, “We are always made very welcome by all members of staff” and each respondent felt there were sufficient staff providing care at the home. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 20 There have been some staff changes since the last inspection. Recruitment files were examined for four new staff, each file contained all required documents including proof of identification, Criminal Records Bureau checks and work permits where necessary. Training files of three staff were examined and found to be in good order with mandatory training up-to-date and good progress with National Vocational Qualification. The home has two staff with the Registered Managers Award, two with National Vocational Qualification level 3, four with level 2 and its own internal verifier and two assessors. Three new staff have commenced level 2 and one person is progressing with level 3. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is managed by a competent and qualified person, ensuring continuity of care and that needs are met. There is effective monitoring by the provider to ensure that standards of care meet the needs of service users. Health and safety is well managed, ensuring that staff, service users and visitors are not placed at risk of harm. EVIDENCE: The manager is registered with the Commission and has achieved the Registered Manager’s Award. She has made significant progress in meeting standards since joining the home and practice is more professional and designed to meet individual needs. A health care professional described Woodstock as a “very well managed home”. The inspection has confirmed this. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 22 The provider carries out regular monitoring visits to the home and has forwarded copies of reports to the Commission. An annual quality assurance audit was due to take place around the time of this inspection. Various health and safety checks are undertaken at the home. Portable electrical appliances had been checked in March this year, the fire log showed that regular fire safety checks are undertaken with good explanatory notes to support records of fire drills. A fire based risk assessment was in place and recent servicing of fire equipment had been carried out by contractors. Pest control had been contacted in the summer to respond to wasps and an annual inspection of the premises for pests had been carried out in October this year. There was a current gas safety certificate which included servicing of the home’s boiler. A sample of water had been sent away for analysis in September this year, to test for Legionella species, and was found to be satisfactory. Records showed that clinical and sanitary waste is disposed of safely. Checks for visual hazards were being undertaken with records showing that these had been done monthly. Hot water temperatures were being checked and recorded and all were within safe temperature ranges. Fridge and freezer temperatures were also being checked regularly and showed that appliances were working within safe temperature ranges. Core food temperatures of cooked foods were being tested to ensure that any food poisoning bacteria would be killed. Accident records showed that no injury had been caused to a service user during 2006 and just one minor accident had happened to a visitor to the premises. The home had a current certificate of satisfactory electrical installation. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 24 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 YA9 Regulation 13(5) Requirement Service users’ risk assessments are to be reviewed and then evaluated at least annually. Timescale for action 01/02/07 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 2 3 Refer to Standard YA17 YA20 YA22 Good Practice Recommendations The approval of an environmental health officer needs to be sought regarding the siting of a fridge in the laundry. The most up-to-date version of the medication policy is to be available in the home. Verbal concerns are to be noted in the complaints log. Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Burgner House 4630 Kingsgate Cascade Way Oxford Business Park South Cowley Oxford, OX4 2SU 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 Woodstock DS0000023037.V311019.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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