Inspection on 30/06/05 for Woodthorne

This inspection was carried out on 30th June 2005.

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

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

Other inspections for this house

Woodthorne 21/08/07

Woodthorne 26/01/07

Woodthorne 16/12/05

Woodthorne 19/01/05

Woodthorne 29/07/04

Woodthorne 26/03/04

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 Woodthorne 12 Thompson Street Willenhall, West Midlands WV13 1SY Lead Inspector Chris Fuller Unannounced 30th June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Woodthorne Address 12 Thompson Street, Willenhall, West Midlands, WV13 1SY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01902 606365 01902 606365 sallychalhal@yahoo.co.uk website: woodthornecarehome.co.uk Miss Satwant Chahal Miss Satwant Chahal Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2005 Brief Description of the Service: Woodthorne is a Victorian detached property situated on the outskirts of Willenhall. It is close to local amenities. Woodthorne is a registered care home for 20 older people. The home has been extended and now includes a single storey extension to the side of the existing property. The home provides eleven single rooms and five double rooms, providing 21 in all. There are wash hand basins in all the rooms. In addition to the lounge and dining area, there is a very pleasant conservatory which overlooks an attractive patio and garden. There is ample car parking space. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This year the Commission for Social Care Inspection is making a proportional inspection based inspection against a selected number of the National Minimum Standards. The focus remains on assessing the quality of care provided through the experience and outcomes for service users, a review progress on meeting National Minimum Standards from last years inspections and focusing on aspects of service provision that require further development, or pose the most significant risk to service users. Some standards have not been inspected on this occasion. The unannounced inspection of Woodthorne residential home was made on Thursday 30th June 2005. The registered person/manager and assistant manager arrived during the morning to assist with the process of the inspection. There were seventeen residents at the home and a further two were in hospital at the time of the inspection. The Inspector spoke with care staff and service users. Records and staff files were seen. A tour was made of the communal areas of the premises and some of the individual rooms. There continues to be progress with the outstanding statutory requirements and plans are in place for external and refurbishment works to be done during the summer. The feedback from service users was positive about the personal care provided by staff and the food provided. There was a relaxed and friendly atmosphere in the home. Maintenance and repairs had mostly been done or planned. There are a few longstanding statutory requirements that remain. It was agreed that the health and safety issues must be given priority. The registered person / manager must take appropriate and timely action to address the outstanding requirements and recommendations contained in this inspection report and provide an action plan to CSCI with timescales for works to be done. What the service does well: The home does have a number of shared rooms to offer to married couples and or those that prefer to share, enjoying the companionship of others. The premises offer a Victorian building with traditional features of stained glass, high ceilings offering a spacious environment and the outlook of a pleasant garden to view or sit in and enjoy. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 6 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. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3 and 4 The home has made some progress with development of the systems and procedures for admissions. These improvements need to be implemented by management and through instruction to all staff to ensure all residents care needs are met. EVIDENCE: Some work has been done to organise the residents files and to produce comprehensive up to date information. The registered manager stated that all residents have received Contracts from the Local Authority or Terms and Conditions issued by the home. A sample of records seen did not detail the Room No’s and some files do not hold a copy of the Contract/ Terms and Conditions issued. An assessment of the prospective residents needs is made prior to admission by the Social Care Health Team, the Health Authority and other relevant professionals; copies of these were seen on file. The home also completes their own assessment during the admission process. The assessment format has been updated to include use of the commode. Once it has been determined the home can meet the needs, a letter is sent out to confirm a placement can be offered. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 Some progress has been made with a review and update of individual care plans with the involvement of residents and their relatives ensuring their wishes and preferences are respected. EVIDENCE: A sample of residents files were found to hold the relevant assessments and care plans developed to reflect the needs identified. The care plan details the action to be taken to address all health, daily routines, hobbies and interests and mobility and personal care issues. At the last inspection there were several areas to be included in the care plan. The care plan format has been improved and senior care workers have been delegated the task of reviewing all care plans to include information relating to the use of commodes, preferred daily routines, daily living skills, health care needs, facilities in bedrooms and suitable activities. Care plans are reviewed monthly. Daily reports and the communication diary record visits from health care professionals such as GP, District Nurse, Optician, Dentist, Chiropodist and Social Worker from the Mental Health team. Staff are kept informed of any changes to care plans at handover meetings, through use of care plans and instructions from the senior staff on shift. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 10 The provision of a Loop system in the main lounge has been beneficial to those with a hearing impairment. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 14 There has been an improvement in the working and social relationships within the home and this is reflected in the cheerful and relaxed atmosphere. Staff are making efforts to ensure individual lifestyle preferences are clearly recorded and implemented to reflect and meet their social and cultural needs. EVIDENCE: The residents had a wide range of individual needs and abilities. The majority of residents were elderly requiring some assistance with personal care needs, a number had sensory impairments, some were wheel chair users, some had a learning disability and a few were still semi independent. There was evidence in records that residents are encouraged and assisted to maintain their independence and daily living skills. Records reflected the individual preferences and interest in respect of leisure and social activities. One person used to attend the Salvation Army luncheon club and had continued with this for a short time. Other interests were Bingo, Gardening, Newspapers, knitting and reminiscence. There has been some progress with the provision of social activities as listed above and addressing individuals stated preferences in their daily routines. There are some leisure facilities in the home such as garden and garden furniture, games and dominoes, tapes and music centre, TV and DVD. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 12 The home does celebrate the main events and individual birthdays. There have been day trips to Weston Super Mare and outings to garden centres, pub lunches. The local church also visit and will provide a service if this is requested. The annual budget did not reflect any allowance made for leisure and social activities; the registered manager confirmed that this was generally covered through petty cash. The residents and their relatives are encouraged to participate in the social events in the home as well as to maintain their own personal interest and social/ leisure commitments. Where individuals do not have visitors’ staff support them to make choices and express their preferences. The management have obtained information about Advocacy services with leaflets held in the office. It was agreed these would be made available to residents and distributed to notice boards in communal areas. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Complaints are addressed in a timely manner with effective use of policy and procedures to ensure that residents, relatives and staff concerns are listened to and resolved in appropriate manner. EVIDENCE: The registered manager reported that there had been no complaints since the last inspection. In the previous inspection year there had been a number of complaints on a range of issues. These were all investigated and addressed appropriately with action taken to improve service delivery where necessary. Staff awareness has been raised of the complaints process and the importance of listening to and addressing issues or concerns as they arise. The home has a complaints policy and procedure. The information is available to service users and their relatives of how to make a complaint including details of how to contact the Commission for Social Care Inspection. Wherever possible the registered person / manager asks staff to address the issue as soon as it is brought to their attention and / or bring them to the attention of management. The registered person / manager takes complaints seriously and follows a process of investigation and looks for lessons to be learnt, regardless of the outcome and addresses these with the staff group. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,22 and 24 There are ongoing repairs, replacement, decoration and maintenance of the premises and grounds. Priority must be given to the health and safety issues in the home to provide a safe and comfortable environment for residents. EVIDENCE: Safety requirements from the last inspection had been met with the fire blanket in the kitchen being resited, ventilator shaft was cleaned and the trip hazard repaired. Fire doors have all been upgraded. There is a maintenance person available for immediate repairs and planned work. A record is kept of work completed, it was agreed that this should also record when the repair was identified. The registered manager confirmed there are regular checks of hot water outlets and Legionella programme of testing. Bathroom / shower room floors have been repaired and cleansed. The registered manager acknowledges the bathroom / shower room facilities need to be refurbished and will include these in the annual development plan. New outdoor design with colourful and scented planting and garden features; create a pleasant garden with suitable seating and tables on the patio area. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 15 There are new storage sheds for cleaning products and garden tools and furniture. Internal storage room in the cellar has been improved with repainting and white melamine surfaces for tinned goods storage. The communal rooms and bedrooms have been refreshed with new curtain rods and curtains. The carpets in the hallways, communal areas and some of the bedrooms are stained and worn and need cleaning and or replacing. Similarly some of the easy chairs are worn and stained and should be replaced in consultation with the respective resident. During a tour of the premises it was brought to the attention of the registered manager there was seating blocking the Fire Exit in the lounge, this was clearly a semi permanent seating arrangement. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 There has been considerable progress in all aspects of staffing recruitment procedures, staff files, supervision and training. The registered manager has effectively restructured staffing and systems to provide able and competent staff. EVIDENCE: There were a sufficient number of staff on duty on the day of inspection. The registered manager stated there were usually four staff on duty at peak times. On the day of inspection there were seventeen residents with another two in hospital. The home does have a couple of staffing vacancies at the present time but have been able to cover hours by the permanent staff. There has been an improvement in the stability of the staff group and the level of their experience and knowledge. There are six staff with NVQ level 2 qualification. All other staff are enrolled or completing their qualification working towards meeting the staffing ratio of 50 qualified. The sample of staff files seen were restructured with dividers making information easily accessible. Progress had been made in identifying items missing from records and efforts have been made with staff to obtain these. Records do not contain some references that are required in order to provide a robust system of recruitment. Staff are issued with the GSCC code of conduct and a copy of the terms and conditions of employment. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 17 The assistant manager has introduced the Croner Induction pack for new members of staff and established regular foundation training for all staff. The staff stated they appreciated the training opportunities and the benefits to their care practice. Topics still to be provided are Infection Control and the accredited safe handling and administration of medication. The registered manager intends to support the assistant manager to attain relevant qualifications and training in line with duties and responsibilities. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 36, 38 There has been progress in the operational management of the home. The benefits of improved management and staff working relationships are seen in the progress made in the delivery of care provided to residents and the cheerful and pleasant atmosphere in the home. EVIDENCE: At the present time the owner is also the registered manager for the home. The staffing restructure provided an assistant manager and seniors to ensure clarity of line management support for each shift. There is clear delegation of duties and budgets enable staff to be responsible and accountable for their actions. This has allowed for the management team to develop a framework for effective administration and recording systems in the home. As yet there are no clear quality assurance and quality monitoring system to measure success in meeting the aims, objectives and statement of purpose of the home. The staff consult and consider residents and relatives feedback but this tends to be in an informal manner and is not collated or published. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 19 The registered person is regularly in the home and addresses issues as they arise. As yet there has been no formal annual development plan for the home; it was agreed this was particularly important for addressing statutory requirements in respect of major outlays or replacement of equipment, works to the premises and staff development or training. The registered manager did provide for inspection a financial summary which had headings covering most aspects of the home’s outlay. It was agreed this would be revised to reflect the actual spending on such items as residents activities. Progress has been made by the assistant manager in the arrangements for supervision and appraisal of staff. Records seen were of irregular sessions and a new member of staff had none recorded. There were records of observations of practice which are useful as evidence for discussion in supervision and appraisals. It was agreed an annual programme of planned supervision sessions and record of completion would organise this task and provide a monitoring tool of sessions completed and any gaps. The registered manager generally gives a priority to health and safety issues. There are some statutory requirements outstanding that need to be met in respect of Fire safety and electrical wiring certificate for the home. This standard(38) was not fully assessed on this occasion. Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 x COMPLAINTS AND PROTECTION 2 x 2 2 x 2 x x STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 1 3 x 2 x 2 Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2.2 Regulation 5(1)(b) Requirement Update Terms and Conditions / Contract to include Room No’s. Issue to all service users with a copy to be held on file. Ensure all staff administering medication have completed the accredited medication training. Ensure the personal care needs of every service user are reassessed regarding the use of a commode and reviewed with the care plan each month. (Timescale of 31/12/04 not met) Provide a budget for leisure and activities. The registered person / manager must provide opportunities for stimulation through activities with particular consideration given to people with dementia, and those with visual and hearing impairments. (Timescale of 31/12/04 not met) The registered person / manager must ensure that the service users and their relatives are informed of how to contact external agents (e.g. advocates) who will act in their interests. (Timescale of 31/12/04 not met) The following work must be Timescale for action 31/07/05 2. 3. 9.7 10.1 13(2) 12(4) 30/09/05 31/07/05 4. 5. 12.1 12.3 16(2) 16(2) 30/09/05 31/08/05 6. 14.3 12(3) 31/07/05 7. 19.1 23(1)(a) 31/07/05 Page 22 Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 8. 19.5 23(4) 9. 10. 20.7 & 24.4 20.7 & 24.4 22.1 16 (1)(2)(c) 16 (1)(2)(c) 16(1) & 23(2) completed in the kitchen: Walls and floor tiles and grouting must be deep cleansed and or decorated. The kitchen units and cupboards must be replaced. Broken tiles around the door frame must be replaced. Consult the Fire Officer regarding immediate the Fire Exit arrangements in the main lounge ensuring Fire Exits are kept clear at all times. Clean and or replace carpets. 30/09/05 Replace worn and soiled Easy Chairs. Clean fabric and revarnish woodwork on Easy Chairs The Registered Provider must ensure that an Assessment of the premises and facilities is undertaken by a suitably qualified person including a qualified Occupational Therapist; (Timescale of 2002 not met) Staff records must include : Interview question and answers, Health declaration and Photo. Ensure staff receive training in infection control. Ensure the Assistant manager completes the management qualification and training relevant to the post including Supervision Skills. Provide an effective quality assurance and quality monitoring system to measure success in meeting the aims, onjectives and statement of pupose of the home. The registered person must provide an annual development plan for the home. Provide evidence of feedback sought from residents used to inform planning and reviews. 30/09/05 11. 31/08/05 12. 13. 14. 29.1 30.2 30.2 19 12 & 18 12 & 18 31/08/05 30/09/05 30/09/05 15. 33.1 24 30/09/05 16. 17. 33.2 33.6 24 24 30/09/05 30/09/05 Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 23 18. 19. 36 38.3 18 13(3) Provide an annual programme of 31/07/05 planned supervision sessions and record of completion. Provide a current five yearly immediate inspection certificate of the electrical installation undertaken by a competent electrician. 20. 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 7.4 Good Practice Recommendations It is recommended for good practice that a six monthly review is offered and held for all private service users with their relatives and for others where the statutory review has not taken place. The Registered Person / manager must ensure that the bathrooms and shower rooms are refurbished: The home must provide an assisted bath on the first floor suitable to meet the assessed needs of service users. (Timescale of 31/12/04 not met) 2. 21.4 & 22.4 Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 Page 24 Commission for Social Care Inspection Mucklow Office Park West Point, Mucklow Hill Halesowen B62 8BR 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 Woodthorne E55 S33323 Woodthorne V236743 300605 Stg4.doc Version 1.40 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. 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