Care Home: 44a Harriotts Lane

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What the care home does well This is a new care home that has been set up specifically to suit the needs of the clients that now live in the home. The service users are profoundly disabled and unable to communicate verbally; despite this, the Proprietors worked with their advocates, family and care manager to ensure that the house is suitable. The Statement of Purpose has been reviewed and kept up to date. The assessment proceedure is robust and operates in conjunction with the developed strategy to fully inform placement decisions, based upon sound planning of both need and finance. Various professionals have given very positive feedback to the registered persons on the standards in the home. "Person Centered support" is used to provide good quality care and support for the service users. Religious and cultural differences are respected and those living in the home have a varied and active lifestyle. A programme of staff training is ongoing to meet the needs of the service users. There is a good relationship with the Community Team for people with learning disabilities (CTPLD), which includes the community nurses. Care staff support service users to access their appointments. What has improved since the last inspection? This new service has been registered for only three months so all the service users have been admitted recently. What the care home could do better: The radiators are not covered and in some areas the surface temperature was too hot for safety. A risk assessment is to be carried out. There are plans to improve access to the back garden and to have decking with a sensory garden for the enjoyment of service users living in the home. In addition, the Proprietors are considering an extension to the property so that four people can be accommodated; at the same time the utility room will be enlarged and a conservatory built to provide additional living space. CARE HOME ADULTS 18-65 44a Harriotts Lane Ashtead Surrey KT21 2QB Lead Inspector Sandra Grainge Unannounced Inspection 22 November 2007 09:30 nd 44a Harriotts Lane DS0000070176.V353589.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 44a Harriotts Lane DS0000070176.V353589.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. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 44a Harriotts Lane Address Ashtead Surrey KT21 2QB 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) 01276 514051 N/A N/A Mrs Linda Mary Miles Mrs Sarah Storey Mrs Linda Miles Care Home 3 Category(ies) of Learning disability (0) registration, with number of places 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care home only - (PC) to service users of either gender. Whose primary care needs on admission to the home are within the following category: Learning disability (LD). The maximum number of service users to be accommodated is 3. 2. Date of last inspection New Service Brief Description of the Service: 44a Harriotts Lane is a new small care home registered to provide accommodation and personal care for three people who have learning disabilities. The property is owned and operated by Mrs L. Miles and partner Mrs S. Storey, working under the name of Choice Care Group. 44a Harriotts Lane is a large detached bungalow that was built in 2006 and is located along a private drive off Harriotts Lane, a residential area of Ashtead in Surrey. The accommodation includes three single bedrooms, a spacious kitchen/diner, large lounge, utility room, large bathroom, separate toilet and an office. There is a good-sized secluded garden to the rear and parking spaces for three cars at the front of the property. The fee is £1,980 per week. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 44a Harriotts Lane is a new service that was registered on 10th August 2007. Mrs Sandra Grainge, locum Regulation Inspector, carried out this unannounced key inspection site visit for the Commission for Social Care Inspection (CSCI) using the Inspecting for Better Lives process. Mrs L. Miles, the Registered Person, was working in the home and assisted with the inspection process. A full tour of the premises was carried out and a number of records and documents were sampled, including policies and procedures, service users individual files, medication records and staff recruitment and training files. Care for all three service users was case tracked. I spoke to all the service users and staff on duty during the time of the visit and was welcomed to observe service user’s life in the home and staff interaction with them. No visitors or relatives came to the home during the five hours that I was there. An Annual Quality Assurance Assessment (AQUA) was supplied to the home and this was completed and returned. Information provided in the AQAA informed this report. A number of CSCI feedback forms were supplied to service users, their relatives, an advocate and to healthcare professionals involved in their support. The return of surveys was not good; I spoke to the advocate who informed me that she has no concerns about the service and feels that the service users have benefited from the resettlement. What the service does well: This is a new care home that has been set up specifically to suit the needs of the clients that now live in the home. The service users are profoundly disabled and unable to communicate verbally; despite this, the Proprietors worked with their advocates, family and care manager to ensure that the house is suitable. The Statement of Purpose has been reviewed and kept up to date. The assessment proceedure is robust and operates in conjunction with the developed strategy to fully inform placement decisions, based upon sound planning of both need and finance. Various professionals have given very positive feedback to the registered persons on the standards in the home. “Person Centered support” is used to provide good quality care and support for the service users. Religious and cultural differences are respected and those living in the home have a varied and active lifestyle. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 6 A programme of staff training is ongoing to meet the needs of the service users. There is a good relationship with the Community Team for people with learning disabilities (CTPLD), which includes the community nurses. Care staff support service users to access their appointments. 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. The summary of this inspection report can be made available in other formats on request. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 7 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 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4, and 5 for a new service were inspected. Quality in this outcome area is good. Prospective Service users and their advocates have enough information to inform choice; needs are assessed prior to entry to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a relevant comprehensive statement of purpose in place. In addition, a pictorial a service user guide was available. All three service users had recently been admitted to this new service The needs of each person had been assessed by a multi disciplinary team and recorded both by staff at the prior NHS placement and the transition planners. The service manager had carried out assessments to ensure that staff could meet the assessed needs. The completed needs assessment forms have been used to provide a holistic picture of service user needs. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 9 Prospective service users and their relatives had been invited and brought to visit the property. The manager informed me that each person has a contract for care. These documents are not currently kept in the home; the manager will arrange for a copy to be kept in each person’s file. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, and 9. Quality in this outcome area is good. Each service user has a plan of care that meets their individual assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user files have been compiled from the assessments and planned care details. As part of “ person centred support” each file is used by staff to ensure that the individual is understood and appropriately supported. Servie user involvement in this process is difficult due to their disability and non verbal status. There was evidence of involvement of relatives and a designated advocate, who was involved throughout the resettlement process, in the planning of support and care. This process is planned to continue to encompass all future arrangements for the service suers. Although a survey 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 11 was not completed by the advocate on behalf of those in the home she infomed me on the telephone that she was more than satisfied with the care that has been given so far. During the visit I observed members of staff as they offered support to assist individual service users to chose and make decisions about daily life. This new approach is in its early stages but already service users are reported to be responding to the new situation and enjoying the life in the home. I saw them smiling, laughing and being pleased with their interaction with staff. Staff noticed that service users like to come back to 44a Harriotts Lane ; this was evident particularly after a visit to the old placement to meet up with their long term friends. Care plans are reviewed and staff keep a record of how each service user spends her time. A keyworker system is in place; the relatives are involved and there is specialist medical, therapist , nursing and social care involvement in treatment programmes. These will continue to be available from the previous provider. Risk assessments are in place for safety and include the use of a box type bed and kirton chair with a lap strap. These are used to manage the behaviour and safety of one servie user who has a history of self harm. Statements are in place concerning the use of this equipment. All are aware of the use of the equipment that is for the safety of the service user. She clearly feels safer and more comfortable when using her special chair and bed. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14,15, 16 and 17. Quality in this outcome area is good. Service users have an opportunity to experience a more appropriate lifestyle in this small care home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some staff are aware of makaton and sign useage ; these were not used by servie users in their previous placement but the manager plans to develop use to improve service user ability to communicate and participate more in activities of the home and their leisure. None of the service users is able to have a job or participate in education or training. An activities programme is in place; service users’ preferences and interests are noted in their individual plans. They are regularly taken out on trips, shopping expeditions, and wheelchair walks to areas of interest near the home. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 13 Service users are unable to respond to questions as all non-verbal but I observed that they can make their preferences clear, one service user was seen to be able to make clear choices. Staff are enthusiastic about improving service users lifestyle and are seeking new ways to understand the responses they make. There was evidence that service users are encouraged to have regular contact with their family and keep in touch with friends. Arrangements had been made to take all the service users to meet with friends from their previous home; in addition a party had been held for them in this new setting. No volunteers are currently used in this service. The service users have brought personal possessions with them to make it feel like home and staff are working to ensure that each person has all the aids and amenities possible to give quality of life. This was illustrated by the manager’s loan of her own music system to provide quality music to a service ser who is very responsive to music. Service users were seen to enjoy their lunchtime meal; staff know their likes and dislikes and were available to discretely assist people to eat with dignity. The menu is wholesome, varied, well balanced and suited to service users’ needs. Person centred support covers all areas of life: practical areas of essential skills, daily living skills, personal care and presentation, community involvement and leisure. Different living styles are offered to meet the needs of the service users living in the home. Each service user is treated as an individual. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. Quality in this outcome area is good. Service users receive the support and personal care needed to meet their physical, emotional and spiritual needs in a way that is appropriate and pleasing to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager is working with the community team of the local primary care trust to develop a health action plan for each person. The service has good relationships with Community Team for people with learning disabilities (CTPLD), including community nurses. In addition arrangements have been made for the provision of service with the local doctor, district nurse and a dentist. Care staff support service users to access their appointments. The home keeps a record of visits by healthcare professionals; none visited during the inspection visit. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 15 Some of the service users had arrived with specialist equipment such as chair, bed and hoist to enable safe living and transfers. There are plans to improve moving and handling by the addition of ceiling hoists to the property. The manager is aware of the need to regularly service and replace such equipment as it becomes worn. Each individual had her own key worker. Their role includes assisting the service user to choose individual clothing to suit personality and taste. The experienced staff were seen to treat service users respectfully and with regard to privacy and dignity, especially when carrying out transfers into the home’s transport vehicle. Again, staff confirmed that they had been trained to do this. No medication was due for administration during this unannounced visit so I was not able to observe staff practice, although they informed me that they had been trained. Medication records were seen, the MAR charts were complete, receipt and return of medication is recorded and a pharmacist gives advice. The medication storage facilities meet the required standards. The manger was advised to consider a long-term strategy for the management of service user serious illness and aging. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. The management has arranged to safeguard service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An advocate works on behalf of the three individual service users who live in the home. A complaints procedure is in place and displayed. There is a record book for complaints kept in home, one complaint had been received and managed appropriately within the allotted time scale. Staff have been trained and know about procedure for safeguarding of vulnerable adults. The home has an up to date copy of the Local Authority multi disciplinary procedure for the protection of vulnerable adults. Management of service users’ personal allowance was reviewed; policy and proceddures are in place and were seen in operation. A locked cash system was seen; invoices of spending are kept . The manager has details of service users’ financial accounts and is engaging with relatives to encourage spending to benefit service user lifestyle; for example a quality music system for a blind disabled service user who clearly enjoys her music. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 17 44a Harriotts Lane DS0000070176.V353589.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30; all standards were included for this new service. Quality in this outcome area is good. The accommodation for this new service has been chosen for its purpose. Service users live in an environment that is homely, comfortable and adapted to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The property is new build bungalow built to a high specification; it has been adapted and designed in order to meet the specific needs of service users. It is attractive, clean, spacious and light. Situated in a residential area of Ashtead there is good access to local facilities. Each service user has a single bedroom. The amount of personal possessions varies according to family involvement. The manager wants to develop the individuality of each room and is working with the relatives to achieve this. Some bedrooms are to be fitted with an overhead track hoist to assist moving and handling. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 19 Emphasis has been placed upon the need to ensure that access for wheelchair dependant clients has been fully addressed, along with attention to all health and safety issues. There is a range of communal areas where service users can meet, socialise and interact, as well as carry out various leisure activities. The large bathroom has been fitted with equipment to assist the disabled. A clinical waste collection is in place; the utility room is small but contains a washing machine that is capable of sluice and hot wash cycles to an infection control standard. There are plans to enlarge the room when application is made to alter the building. There is central heating in the building that was pleasantly warm; however, some radiator surfaces are hot to touch and present a safety hazard. A risk assessment is required and a plan for appropriate provision of safety measures. The rear garden is secluded and being developed with more planting and plans for a larger patio. The manager has sought legal and community advice to address a problem of antagonism from a neighbour. 44a Harriotts Lane DS0000070176.V353589.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35. Quality in this outcome area is good. Service users are given support and care by properly recruited staff who are being trained and supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff have been recruited correctly and the new team includes some experienced trained carers. I saw staff training records and staff confirmed that they had received the training. More is planned to achieve at least 50 care staff with NVQ level 2 in the near future. I observed good practice in communication and moving and handling; staff were seen to have the skill and motivation to develop and enjoy a relationship with the service users. All the staff I spoke to had a willingness to engage with service users and to encourage as much independence as possible. There was evidence in staff files of induction training and supervision. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 21 Sufficient numbers of staff were available at the time of the visit and in dicated on rota. Initial estimates for staff numbers and rotas have been reviewed to meet actual service user needs. Staff recive training in diversity and client need. A clear whistleblowing policy has been produced. 44a Harriotts Lane DS0000070176.V353589.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42. Quality in this outcome area is good. Service users live in a home that is managed and administered to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has commenced training for the registered managers award. She is experienced in relevant fields for social care and personal support for service users. Her partner has financial and complimentary management skills. All files and records seen were in good order and there was evidence of efficient administration. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 23 There was an open and positive atmosphere in the home. The staff considered themselves part of a team. The manager has an enthusiastic approach to the provision of care and equal opportunities for development of staff. The management have a plan to send quality assessment forms to families and professionals. An external consultant provides advice and feedback on the service and staff to ensure provision of a quality service. Records inspected for fire safety , health and safety at work, moving and handling, first aid, gas and electrical services, and COSHH were found to be in place. 44a Harriotts Lane DS0000070176.V353589.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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 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 3 3 X LIFESTYLES Standard No Score 11 X 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 4 3 X 4 3 X 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A New Service 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(2) p Requirement The Registered Person to carry out a risk assessment of danger to service users from contact with hot unprotected radiator surfaces and send details of outcome and action taken to CSCI. Timescale for action 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA39 Good Practice Recommendations Regulation 26 reports could be designed for use as part of the quality Control system. 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 44a Harriotts Lane DS0000070176.V353589.R01.S.doc Version 5.2 Page 27 - 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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