CARE HOME ADULTS 18-65
Yeldall Manor Blakes Lane Hare Hatch Reading Berkshire RG10 9XR Lead Inspector
Marie Carvell Unannounced Inspection 31st August 2006 10:00 DS0000011361.V297884.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 DS0000011361.V297884.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. DS0000011361.V297884.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Yeldall Manor Address Blakes Lane Hare Hatch Reading Berkshire RG10 9XR 0118 940 4411 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) Yeldall Manor Christian Centres Mr Noel Alexander Fawcett Care Home 27 Category(ies) of Past or present alcohol dependence (27), Past or registration, with number present drug dependence (27) of places DS0000011361.V297884.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: Yeldall Manor is a drug/alcohol residential rehabilitation centre for up to 27 men between the ages of 20 and 40 years, which operates within a Christianbased treatment ethos. Each resident signs a personal contract which binds him to the conditions of residence and to complete the rehabilitation programme at Yeldall Manor. The contract acknowledges that Yeldall Manor operates certain practices and policies which would normally fall outside of mainstream care practice in residential care homes. Yeldall Manor is located in a large period house set in a thirty-eight acre rural estate between Reading and Maidenhead. The estate includes fields, workshops, vegetable garden, picnic area, football and volleyball pitches, a swimming pool and areas of woodland and lakes. Up to twenty-seven male residents are accommodated in the main house and its annexe, which together have 8 double rooms and 11 single rooms. The fees charged are £535 per week. Depending on the personal financial situation, a service user can either pay the fees privately or receive benefits arranged through Social Services, Probation or Health Authority. Fees do not include telephone calls (except to funding authority) and some travel costs (except voluntary work experience, healthcare appointments and organised trips). DS0000011361.V297884.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report has been prepared using information provided on the preinspection questionnaire completed by the manager; our inspection records held at the local CSCI office; four service user surveys and an unannounced site visit on the 31st August 2006 from 10am until 4pm. During the site visit time was spent with manager, staff on duty, including two counsellors, nine of the twelve service users and briefly with the Responsible Individual. The inspector joined service users for lunch and was invited to observe a service user’s four week assessment review meeting. A tour of the communal areas of the home, some service user bedrooms and recreational facilities. A sample of records required to be kept in the unit were examined including the case tracking of four service user files. At the last inspection in November 2005, one recommendation and four requirements were made. These were that the remaining fire safety work must be scheduled in accordance with the priorities agreed with the fire officer, that the CSCI are advised in writing when the fire safety work is completed. These have been complies with fully. That Quality Assurance feedback is sought from appropriate additional parties on the effectiveness of the service and a summary report of the results of the quality assurance survey should be made available to the service users and the inspector. These requirements are still in the initial planning stage and the inspector agreed an additional timescale until the end of November 2006 for compliance. The recommendation made was that consideration should be given to establishing a written rolling programme for the redecoration of the building. This has not been addressed and is subject to requirement. It was agreed with the manager that the term resident is used for service users. What the service does well:
The unit has a clear criteria for admission, supported by appropriate risk assessments. If a place is offered, then this is for an initial four week assessment period in the unit, during this period certain objectives have to be achieved by the
DS0000011361.V297884.R01.S.doc Version 5.2 Page 6 prospective resident to demonstrate his commitment to treatment. This includes writing an autobiography and completing a test on the unit rules, as well as demonstrating a positive attitude to the programme. All residents take part in a set treatment programme with defined stages, within which an individual contract is devised during the six months “Regeneration Phase”. This contract is their care plan, outlining targets for the individual to achieve; all targets are agreed with the individual’s counsellor. Each resident works on his goals with support from his named counsellor and trainee counsellor. Towards the end of the programme, residents are assisted to find work placements or to undertake further education at local colleges. Residents also go off site to do voluntary work. Residents are able to attend external Alcoholics Anonymous or Narcotics Anonymous meetings during their “ regeneration” phase and with the counsellor’s agreement may go alone. Residents’ spoken to were generally positive, some felt that there were too many restrictions, but also said “ You soon get used to them”. Several residents said that there should be more counselling sessions available. This was discussed with the manager. One resident said, “ This is the first time in my life, that someone is listening to me, really listening to what I am saying”. Most residents said that they probably wouldn’t complain as “Everyone just moans between themselves”, however, all said that they were confident that the manager or a member of staff would deal with any complaint. The CSCI has not received any complaints about this service since the last inspection. The unit has received ten complaints; these were appropriately recorded, with action taken and outcomes recorded. The housekeeping staff work hard to maintain an homely environment. Staff spoken to expressed their satisfaction of working in a environment, which had positive outcomes for residents and of the support and encouragement received from the manager. Communication systems in the unit are well established and staff meetings take place daily. Residents feel that their views are listened to. There is a resident’s board, which meets each week. The board cannot make decisions, but they are able to make recommendations to a full residents’ meeting and/or the manager. Members of the board need to be elected and stand for two months. DS0000011361.V297884.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. DS0000011361.V297884.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 DS0000011361.V297884.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 and 4 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Prospective residents are fully assessed prior to admission and are able to visit the unit beforehand, unless they are coming from prison, when this may not be possible. EVIDENCE: Four resident’s file were case tracked and demonstrated that a comprehensive assessment is carried out prior to an offer of a place on a treatment programme being made. The unit receives an initial referral application, with supporting reports and background history from appropriate professionals. All applications go to the referrals co-ordinator. Assessments are completed on the risks of self harm, suicide and risk or harm to others. All prospective residents must demonstrate their commitment to the Christian based ethos of the unit. If the prospective resident meets the criteria, then a visit to the unit for interview is arranged. In some circumstances the interview is carried out in prison. During the visit to the unit, the prospective resident is shown around the premises and facilities and is encouraged to join other residents for lunch and a chat. Once the interview and assessment forms have been completed, the paperwork is then sent to the manager together with a recommendation, for a decision to be made. DS0000011361.V297884.R01.S.doc Version 5.2 Page 10 If a place is offered, then this is for an initial four week assessment period in the unit, during this period certain objectives have to be achieved by the prospective resident to demonstrate his commitment to treatment. This includes writing an autobiography and completing a test on the unit rules, as well as demonstrating a positive attitude to the programme. At this stage, residents also complete the first of two quality assurance questionnaires as part of the units quality assurance systems. The second questionnaire is completed after three months on the treatment programme. DS0000011361.V297884.R01.S.doc Version 5.2 Page 11 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 judgment has been made using available evidence including a visit to the service. Residents have a comprehensive care plan and appropriate risk assessments are in place. EVIDENCE: All residents take part in a set treatment programme with defined stages, within which an individual contract is devised during the six months “Regeneration Phase”. This contract is their care plan, outlining targets for the individual to achieve; all targets are agreed with the individual’s counsellor. Each resident works on his goals with support from his named counsellor and trainee counsellor. The contract is reviewed after three months and any issues identified. On moving to the “Re-Entry” phase of the programme, a separate contract is agreed with the counsellor, with a focus on goals towards re-integration into the community and obtaining employment and housing. DS0000011361.V297884.R01.S.doc Version 5.2 Page 12 The nature of the unit is such that considerable restrictions are placed upon the residents and their right to make decisions is limited by the expectations of the placement. Residents are made aware of the restrictions in place prior to their admission and these are reiterated during the admission and assessment process. Residents have an input into setting their individual goals, and their level of decision making and independence increases as they progress successfully through the programme. Residents as part of the therapeutic process enter a very structured environment and are not encouraged to take risks other than in their counselling sessions when appropriate. DS0000011361.V297884.R01.S.doc Version 5.2 Page 13 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): 11,12,13,14,15,16 and 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents enjoy a wide range of activities and leisure opportunities, which they can do within the community. Opportunities are increased as the resident progresses through the programme. Residents are encouraged to maintain and rebuild appropriate relationships, such as those with members of their family. Strict guidelines on residents’ freedom are in place. Residents are provided with a healthy diet. EVIDENCE: The emphasis of the service is focussed on rehabilitation and equipping the residents for re-integration into the community at the end of the programme. Residents are actively encouraged to explore their feelings and this is seen as an important element of the programme. Regular group sessions are held to develop communication skills and the structured environment assists residents to develop and maintain regular daily living patterns. A wide range of activities and leisure opportunities are available on site. These include sport facilities, swimming pool, woodworking shop, music room and
DS0000011361.V297884.R01.S.doc Version 5.2 Page 14 gardening. As residents progress through the programme, opportunities to access activities in the community, which are less supervised can be made with the counsellor’s agreement. However, there are strict guidelines on when and for how long residents can be away from the unit. Towards the end of the programme, residents are assisted to find work placements or to undertake further education at local colleges. Residents also go off site to do voluntary work. Residents are able to attend external Alcoholics Anonymous or Narcotics Anonymous meetings during their “ regeneration” phase and with the counsellor’s agreement may go alone. There are strict guidelines on the freedom of movement for residents. Residents are not allowed to have a key to their bedroom, enter their bedrooms during the day and must agree to routine searches of their rooms. This is clearly written in the resident’s contract and resident’s handbook. Residents are encouraged to maintain and build relationships with their family. However, residents are restricted in how much contact they can have with previous friendships. Residents who have children are able to maintain telephone contact, after the initial assessment period. During the first two weeks of the programme, residents are not allowed to have visitors. All post must be opened in front of a member of staff. The inspector joined residents for the midday meal. A choice of several dishes were served including Lasagne, Fish Fingers, salad and grated cheese and dessert, special diets can be catered for. The meal was served after prayers were said. Food was tasty, nutritious and plentiful. Residents and staff eat together in the main dining room. Residents were complementary about the food provided and the quantities, several residents said that they had gained weight whilst in the unit, after a long period of not eating properly. DS0000011361.V297884.R01.S.doc Version 5.2 Page 15 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 judgment has been made using available evidence including a visit to the service. Residents receive personal support from their peers, the staff team and in groups. The programme identifies and addresses residents’ physical, emotional and spiritual needs. Healthcare needs are provided by the local GP practice and other healthcare professionals. Medication storage, administration and recordings were seen to be satisfactory. EVIDENCE: None of the residents require assistance with personal care other than occasional prompting. Support is available through regular planned, individual counselling and group sessions as well as informal support throughout the day. The structured programme provides a physically, emotionally and spiritually supportive framework, within which residents learn to address their addiction and develop skills to move towards a life without alcohol and/or drugs. Residents’ spoken to were generally positive, some felt that there were too many restrictions, but also said “ You soon get used to them”. Several residents said that there should be more counselling sessions available. This was discussed with the manager. One resident said, “ This is the first time in my life, that someone is listening to me, really listening to what I am saying”.
DS0000011361.V297884.R01.S.doc Version 5.2 Page 16 All residents said that they have a good relationship with their counsellor and other staff. Medication is administered by staff that have received appropriate training. Medication storage and recordings are maintained to a satisfactory standard. Routine health screening is offered to all new residents, this is undertaken by the local GP practice, that provides medical cover to the unit. DS0000011361.V297884.R01.S.doc Version 5.2 Page 17 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 judgment has been made using available evidence including a visit to the service. The unit has a comprehensive complaints procedure and procedures are in place to protect residents from harassment and bullying. EVIDENCE: There is a comprehensive complaints procedure in place and this is included in the Resident’s Handbook. Residents spoken to were clear about the process for reporting complaints. Most residents said that they probably wouldn’t complain as “Everyone just moans between themselves”, however, all said that they were confident that the manager or a member of staff would deal with any complaint. The CSCI has not received any complaints about this service since the last inspection. The unit has received ten complaints; these were appropriately recorded, with action taken and outcomes recorded. The resident’s handbook contains a policy statement on harassment and bullying. This is a detailed, clearly written document and contains the procedure for dealing with harassement. DS0000011361.V297884.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 adequate. This judgment has been made using available evidence including a visit to the service. Residents live in a homely, comfortable environment, which is consistent with the short term treatment ethos of the unit. Since 2003,at each inspection a recommendation has been made that consideration should be made to establish a written programme for the redecoration of the building. This has not been actioned. The unit was found to be clean and hygienic. EVIDENCE: The main communal rooms are well maintained, comfortably furnished with good quality furniture. The housekeeping staff work hard to maintain an homely environment. Some areas of the home were seen to be shabby, with carpet and floor coverings, posing a trip
DS0000011361.V297884.R01.S.doc Version 5.2 Page 19 hazard and needing repair or replacement. It was observed that some walls required attention to plaster and other areas would benefit from redecoration. This is subject to requirement. All areas of the home were seen to be clean, fresh smelling and hygienic. DS0000011361.V297884.R01.S.doc Version 5.2 Page 20 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 judgment has been made using available evidence including a visit to the service. Residents are supported by a experienced and competent staff team. There are robust recruitment procedures in place. Staff receive regular, planned and recorded supervision. EVIDENCE: The unit benefits from a low turn over of staff. All staff have a clearly defined role within the unit. Four staff files were examined and demonstrated that recruitment procedures are robust. There is a detailed induction programme in place for all newly appointed staff. Staff undertake training in fire safety, health and safety, medication administration and protection of vulnerable adults from abuse. Counsellors are trained via the Institute of Christian Counselling. Staff spoken to said that opportunities to attend training courses were promoted. All grades of staff were observed to be carrying out their duties in a professional, relaxed and cheerful manner. It was clear that there is a good rapport between residents, staff and the manager. Formal supervision is provided on a monthly basis, records of supervision meetings were seen to be comprehensive, agreed and signed by both the supervisor and supervisee. Staff spoken to expressed their satisfaction of working in a environment, which had positive outcomes for residents and of
DS0000011361.V297884.R01.S.doc Version 5.2 Page 21 the support and encouragement received from the manager. Communication systems in the unit are well established and staff meetings take place daily. DS0000011361.V297884.R01.S.doc Version 5.2 Page 22 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, 38,39 and 42 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. This is a well managed service and is run in the best interests of residents. At the last inspection two requirements were made regarding quality assurance feedback being sought from appropriate additional parties and the results being made available to residents, an additional timescale until the end of November 2006 for compliance has been agreed. EVIDENCE: The manager of the unit is well qualified, committed and experienced. Both staff and residents were complementary about his leadership and management of the unit. The manager was described as compassionate, kind and approachable. DS0000011361.V297884.R01.S.doc Version 5.2 Page 23 Residents feel that their views are listened to. There is a resident’s board, which meets each week. The board can not make decisions, but they are able to make recommendations to a full residents’ meeting and/or the manager. Members of the board need to be elected and stand for two months. There is an established system of quality assurance process in place; residents’ complete a questionnaire after one week into the programme and then a more detailed questionnaire after twelve weeks on the programme. At the last inspection two requirements were made regarding quality assurance feedback being sought from appropriate additional parties and the results being made available to residents. These requirements are still in the initial planning stage and the inspector agreed an additional timescale until the end of November 2006 for compliance. Records relating to fire, health and safety were seen to be up to date and well maintained. There is a health and safety policy statement with a copy of the document provided to all residents. DS0000011361.V297884.R01.S.doc Version 5.2 Page 24 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 3 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 2 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 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 2 x x x 3 DS0000011361.V297884.R01.S.doc Version 5.2 Page 25 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 YA24 Regulation 23 Requirement That floor covering which poses a trip hazard is replaced or repaired. That a rolling programme is in place for the redecoration of the building. Quality assurance feedback should be sought from appropriate additional parties on the effectiveness of the unit. A summary report of the results of the quality assurance survey should be made available to residents and the inspector. Timescale for action 31/10/06 2. YA39 24 31/10/06 3. YA39 24 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000011361.V297884.R01.S.doc Version 5.2 Page 26 DS0000011361.V297884.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 DS0000011361.V297884.R01.S.doc Version 5.2 Page 28 - 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!
