Inspection on 22/09/06 for Yew Trees

This inspection was carried out on 22nd September 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Yew Trees 06/12/05

Yew Trees 01/07/05

Yew Trees 17/03/05

Yew Trees 28/10/04

Yew Trees 04/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

SignHealth

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

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

CARE HOMES FOR OLDER PEOPLE Yew Trees Yew Trees Lane Dukinfield Tameside SK16 5BJ Lead Inspector Janet Ranson Unannounced Inspection 22nd September 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yew Trees Address Yew Trees Lane Dukinfield Tameside SK16 5BJ 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) 0161 338 3053 0161 303 0072 yewtrees@tamesidecare.co,uk Tameside Care Limited Susan Chadwick Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (40), Physical disability over 65 years of age (40), Sensory Impairment over 65 years of age (2) Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: *up to 40 service users in the category of OP (old age not falling within any other category); *up to 40 service users in the category of PD(E) (Physical disability over 65 years of age); *up to 40 service users in the category of DE(E) (Dementia over 65 years of age); *up to 2 service users in the category SI(E) (Sensory impairment over 65 years of age); *up to 3 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 6th December 2005 2. Date of last inspection Brief Description of the Service: Yew Trees is a large, purpose built establishment, originally commissioned by the local authority; it is now owned and managed by Tameside Care Limited. The home has been extended and adapted over the years to provide care for up to 40 older people, some of whom have a dementia or physical disability. The accommodation is provided in single rooms over two floors, 25 of which have en-suite facilities. There is a full passenger lift and aids to enable the residents mobility. Both floors have lounges and dining areas and there is a designated area on the ground floor for those people who smoke. A large conservatory has recently been added to the ground floor lounge. Small kitchens are situated on each floor where drinks and snacks can be prepared. In addition, there is a small room containing specialist equipment to help those residents with dementia. The home is located on the edge of a residential area with associated local facilities and transport links. There is an enclosed garden to the rear of the home, shared by the adjacent home. Car parking is the front of the building. Fees for accommodation and care at the home range from £375.33 for a single room to £388 for a larger single room with en-suite facilities. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included an unannounced site visit to the home. The site visit took place on Friday, 22nd September 2006, and covered a period of eight and quarter hours from 9:30am until 5:45pm. Time was spent talking to residents, relatives and staff, in addition to observing the home’s routine and staff interaction with residents. A total of four residents’ identified needs were looked in detail. Individual details of their experiences and care were examined from the point of admission to their current care. A tour of the building was conducted and a selection of staff and residents’ records was examined, including records of care, medication records, employment and training records. Questionnaires were left at the home for use by residents, their relatives and the staff to enable them to comment on the service. Written comments have been received from the residents as follows: “very happy living here” “not enough men” “it smells sometimes” “I like arts and crafts. The lady that does them is very nice and always smiles,” “I am very happy.” And from the staff in response to the question “is there anything that the home does really well that you want to tell us about?” “Work hard to meet the needs of all residents, try different things to make the residents happy and settled at our home.” “I think the activities we do help the residents in many ways, e.g., day trips, arts and crafts.” “The staff work well as a team, the seniors and management are always available when needed.” Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 6 “I find it a happy home to work in staff get on really well and I think this happy environment rubs off on our clients, making it more of a home for them.” In addition to carers, the organisation employs administration staff, a maintenance person, teams of catering and domestic staff. What the service does well: The internal and external appearance of the home is of a very high standard and provides a pleasant, comfortable environment for residents to live and staff to work in. The residents have full access to the landscaped garden at the rear of the premises. The garden is secure and shared with the adjacent care home. The residents said that staff were kind and looked after them well. particular, a resident said he knew staff were there to look after him. In Visitors said that they were made to feel very welcome and staff were friendly. They also said they were usually kept in touch about their relative’s care and, at times, supported. The home has a varied activities programme carried out by three part-time dedicated activities organisers. External entertainers also visit the home and there are regular armchair aerobic sessions. The home in general was calm and peaceful, with staff undertaking care tasks in a relaxed and considerate manner. A lunch was observed to be leisurely and residents were afforded the time to eat their meal at their own pace. Each person had been enabled to choose what he or she wanted to eat. The daily menu was clearly written on a wipe clean board close to the dining room. A relative said the meals always looked appetising and nicely presented. Staff team members spoken to had received training in various aspects of their role. What has improved since the last inspection? The home has undergone a total refurbishment since the previous site visit. Great care has been taken to provide a calm atmosphere for the residents by the imaginative use of colour and textures. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 7 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. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality rating in this outcome area is good. The residents and their representatives have access to information about the home to assist them to make an informed choice. Systems are in place to ensure the residents’ needs can be fully identified and met by the home. (Standard 6 Intermediate care is not provided at Yew Trees). This judgement has been made using available evidence, including a visit to the service. EVIDENCE: A range of care records were examined. They all contained pre-admission assessments. The manager or team leaders undertake their own assessment of all prospective residents prior to admission. This information was shared verbally with staff and the written assessment placed on the resident’s care file. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 10 The assessments are corporate in design. They were found to be well documented giving individual details of a “family tree” and previous interests. Two relatives who were visiting the home said they had been involved in the assessment process carried out by the resident’s social worker. One relative stated she was advised by a social worker that staff at Yew Trees had the specialist skills to care for her relative. This had made her feel assured. The home’s statement of purpose and service user guide, located in the main hallway, were available to the residents and members of the general public. The documents provide the full information required to make an informed choice of care home. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality rating in this outcome area is good. The residents’ personal care, health and welfare needs are fully documented and reviewed. The residents’ identified health needs are fully met by the various healthcare professionals and by the provision of specialist equipment. The residents are treated with respect and their privacy is maintained at all times. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The home was calm and peaceful and residents were observed to be provided with assistance in a timely and patient manner. A relative confirmed the atmosphere in the home was usually calm. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 12 A sample of resident care records was examined. They were found to be recorded to an acceptable standard. Assessments recorded at admission to the home were detailed and care plans referred to the resident by preferred title. The care plans were reviewed at regular intervals. Each identified need has a plan of care, which includes personal hygiene, continence issues, mobility and dexterity, moving and handling assessment, tissue viability and nutrition. Visits from the district nursing service, chiropodist, physiotherapist, general practitioner and opticians were all noted within the individual care file. Equipment and aids to daily living could be seen throughout the home. Individual wishes concerning end of life care were not always completely documented. Two relatives said they were highly satisfied with the care provided and felt they were kept informed of any changes in condition. A resident said he was happy at the home and although he could not name the carers, he knew they were there “to help” him. A number of residents’ medication administration records were examined and compared with the individual prescription. They were found to be documented in the approved manner. A local pharmacist provides the home with individual monitored dosage system of medication. All the senior staff have received training in the administration of medication and the organisation has policies and procedures concerning medications. At all times and in both areas of the home staff could be seen and heard to treat the residents with the greatest respect. Carers were observed using good interpersonal skills with the residents who responded in a positive way. The residents were generally appropriately dressed for the season, clean and tidy. All the bedroom doors are lockable and staff could be seen knocking and waiting for a response prior to entering bedrooms. The reason for not providing a bedroom door key was clearly documented within the care plan. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality rating in this outcome area is good. The choices offered to the residents meet with their requirements and needs and enable them to exercise day-to-day control over their lives. The residents can participate in a programme of daily activities. Visitors are made to feel welcome and remain in contact with their relative’s care. The contents of the menu appeared nutritious and well balanced, with a choice provided at each mealtime. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The home’s assessment procedures document the prospective resident’s religion. Spiritual needs are met by churches in the local area who visit the home at regular intervals. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 14 Visitors could be seen throughout the home during the site visit. A relative said she visited at different times of the day and was always greeted warmly. She also said she felt supported by the staff. Two relatives said they were usually advised of any changes in their relative’s care needs. They said this meant they remained involved in the care. Close relatives are also encouraged to maintain contact by supporting their loved one at meal times. There are three part-time activities organisers employed at Yew Trees. They provide a varied programme of activities from group work to one to one discussions or hand massages, all sessions are clearly documented. One of the organisers talked with the inspector. She explained she had recently attended specialist training that had provided her with a greater understanding of the needs and abilities of the resident with dementia. A small room on the first floor has equipment that provides visual stimulation. A resident said that he knew there were activities and “things going on” but had chosen not to participate. A meal was observed at lunchtime. The hot food was served individually from a bain-marie in each of the dining rooms (ground and first floor). Each resident had been assisted to make a choice from the menu the day previously. The daily menu was clearly displayed in both dining areas. The meal looked appetising and was nicely presented. Specialist cutlery and equipment was in use to enable the resident to eat their meal with minimum support. Each resident who spoke with the inspector confirmed the meals to be of good quality and tasty. A resident said he always enjoyed his meals that “they were usually very good.” Snacks were available with the afternoon tea. The carers on the ground floor who were serving the meal were not wearing either a tabard or disposable apron. A three week menu was examined and discussed with the cook. She clearly demonstrated her understanding of individual dietary needs, various likes and dislikes. The kitchen is appropriately equipped, with all appliances reported to be in full working order. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality rating in this outcome area is good. The residents and staff were confident their complaints would be treated with respect and acted upon. The policies, procedures and staff training protect the residents from potential abuse. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The complaints procedure was available in the service user guide; it is also clearly displayed within the home. The residents and their relatives who spoke with the inspector were unable to recall having seen the complaints procedure but were able to tell the inspector how and to whom they would voice their concerns, either to family members or staff. A record is retained of any complaints made to the staff. The record documents the investigation process and the outcome. There have been no complaints made to the Commission for Social Care Inspection since the previous inspection. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 16 The organisation has a policy and procedure to respond to allegations of abuse. In discussion, the carers demonstrated their intuitive awareness of abuse and described how they would report concerns to the manager or registered provider. The care staff have now all received formal training in the Protection of Vulnerable Adults (POVA) as required. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The quality rating in this outcome area is good. Yew Trees provides a warm, clean, safe and well-maintained environment with a good standard of decoration, furnishings and fittings. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: Yew Trees has undergone a total “makeover” since the previous inspection. Great care and attention has been given to provide the residents with colour and texture that creates a calming influence in the home. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 18 The residents and the relatives who spoke with the inspector voiced their satisfaction with their accommodation. A resident invited the inspector to his room. He was proud of the accommodation and appeared to recognise the furniture and other effects as his own property. Yew Trees was found to be clean and tidy with no bad odours. A visitor said there could sometimes be a smell on the first floor and one person had written in a survey “it smells sometimes.” The main entrance into the home is accessible to the visitors by entry phone and all other doors have a system to alert staff when they are opened. The residents are encouraged to use all areas of the home. The garden to the rear of the property is fully accessible to the residents. It is a safe and secure area complete with benches, chairs and tables. A person is employed at Yew Trees to provide general maintenance. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality rating in this outcome area is good. The people who live at Yew Trees receive care from well-trained staff who respond in a respectful manner. In general, the organisation’s recruitment policy and procedure provides protection to the residents from potential abuse, but greater attention is required to ensure the procedure is thoroughly applied. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The staffing levels at Yew Trees have been improved to reflect the residents’ changing needs. The majority of the people who live at the home have been diagnosed with dementia and require skilled care. Some responses in the care workers’ surveys document their concerns regarding the staffing levels and it should be noted that this is different from their views at last inspection, when they said they felt the improvements benefited the residents at this time. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 20 The people who spoke with the inspector said they were satisfied with the numbers of staff on duty, and one person said the managers were always available to speak to them. During the inspection the carers were interacting with the residents and acknowledging them by name. The organisation continues to be committed to the National Vocational Qualifications at levels 2 and 3 and provides specialist training concerning the needs of people with dementia and the management of challenging behaviour. Mandatory training is provided to all staff and there is a system to ensure such training is kept up to date. The organisation has policies and procedures concerning the recruitment and selection of all staff that, if thoroughly carried out provides adequate protection to the residents. A selection of staff files was examined. Greater attention is needed to ensure the applicant’s previous employment history is completed and any gaps investigated and documented. Further to this, in one instance, the references did not reflect the details on the application form. The contents in the references were vague, undated and addressed “to whom it may concern”. One was written on the back of an envelope. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The quality rating in this outcome area is good. The use of questionnaires and continued reviewing of care plans enables the residents and their relatives to be involved in the delivery of care. Systems are in place to protect the residents’ financial interests and to ensure their health and safety at all times. This judgement has been made using available evidence, including a visit to the service. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 22 EVIDENCE: All care plans are reviewed at regular intervals and a relative confirmed his understanding of the reviewing process. A representative of the organisation also carries out regular spotchecks on records, health and safety issues, in addition to seeking the residents’ views of the service wherever possible. An annual satisfaction survey is also distributed to the residents and their families. The outcomes are documented and made available to the general public. The staff survey responses are favourable and document that the staff are proud of working at Yew Trees. They state they work well as a team and enjoy working with the residents. Those staff that spoke directly to the inspector also confirmed that they felt supported by the manager and it was a good home to work at. The staff confirmed they had received all the mandatory training concerning the health and safety of the residents. The organisation also has a system to ensure the training is current. There are procedures to enable residents to maintain their own financial affairs. The home handles small amounts of money on behalf of the residents. Records are retained to account for expenditure. The maintenance of all appliances and equipment is carried out under contract. The health, safety and welfare is further ensured by the systems in place to report accident and incidents. Yew Trees DS0000005587.V312822.R02.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Yew Trees DS0000005587.V312822.R02.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. Standard Regulation Requirement Timescale for action 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 OP29 Good Practice Recommendations The registered person should ensure all applications for work complete a full employment history and two references provided, one of which must be the previous employer. Yew Trees DS0000005587.V312822.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Yew Trees DS0000005587.V312822.R02.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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