Care Home: 63a Victoria Avenue

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What the care home does well Relatives said the home `provides a safe and loving environment` and `they care for my relative`. Assessments are completed before admission, ensuring the service can meet people`s needs. Appropriate aids and adaptations are fitted to meet people`s needs. What has improved since the last inspection? Progress has been made with archiving old information, to make case files and care plans more accessible. The soft room has been completed, offering people who use the service somewhere to go and relax. The manager has met with staff individually and as a team and discussed issues regarding care practices and consistency and is working with the staff team to improve the quality of care provided. What the care home could do better: One person said they could spend `less time in front of the television`. The Statement of Purpose should be updated to reflect the new manager, give the new address of the CSCI and have a copy of the most recent inspection report, to ensure people have up to date and correct information about the service. Further work could be done to care plans to ensure they are more person centred and include details of how individuals want their care to be given. Risk assessments should be more details and include what staff should do in certain situations. Consideration should be given to replacing the lounge carpet and cleaning the carpet in the hallways. The paintwork in hallways is showing signs of wear and the environment would be better if it was repainted. More work could be done to make the place more homely for people who live there. Staff should update their training in safeguarding, to ensure they are aware of their responsibilities. All staff should have one to one supervision with their manager, to look at care practices, acknowledge good work and address areas for development through training courses. The manager must register with the CSCI. CARE HOME ADULTS 18-65 63a Victoria Avenue Wallington Surrey SM6 7JP Lead Inspector Emma Dove Key Unannounced Inspection 30th May 2008 12:00 63a Victoria Avenue DS0000007210.V364286.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 63a Victoria Avenue DS0000007210.V364286.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. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 63a Victoria Avenue Address Wallington Surrey SM6 7JP 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) 020 8669 4559 020 8669 4559 admin.victoriaavenue@careuk.com Care Solutions Limited Manager post vacant Care Home 7 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2. Physical disability (PD). The maximum number of service users to be accommodated is 7. Date of last inspection 17th August 2007 Brief Description of the Service: 63a Victoria Avenue provides residential care for up to seven people with learning and/or physical disabilities. Six people are currently living there. The premises are a modern purpose built two-storey house set back in a quiet residential road. It is situated between Carshalton and Wallington town centres and is also close to local shops and amenities. Each person has a single bedroom and the communal facilities are adapted to meet individual needs. The home has a lift and is fully accessible to the people who live there. Information about the service is available in the Statement of Purpose and User Guide. Fees for the service are currently £1,500 per week. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means people who use this service experience good quality outcomes. This unannounced inspection took place over one hour on the 30th May 2008 and seven and a half hours on the 6th June 2008. One regulation inspector visited, looked at records, spoke with people who use the service, the manager and staff. Questionnaires were sent to relatives and representatives of people who use the service, placing social workers, health professionals and staff. We received three completed questionnaires, comments from these are included throughout this report. The manager completed an Annual Quality Assurance Assessment, which contained good information that is included in this report. What the service does well: What has improved since the last inspection? Progress has been made with archiving old information, to make case files and care plans more accessible. The soft room has been completed, offering people who use the service somewhere to go and relax. The manager has met with staff individually and as a team and discussed issues regarding care practices and consistency and is working with the staff team to improve the quality of care provided. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 6 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. 63a Victoria Avenue DS0000007210.V364286.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 63a Victoria Avenue DS0000007210.V364286.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): 1, 2 and 4 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. It has developed clear information in both written and pictorial format. Assessments are completed before admission. People are invited to visit to look around, meet people who live there and staff before they decide whether to move in. EVIDENCE: The Statement of Purpose has information about the organisation, staff, the aims of the service, consultation, some relevant policies and the last inspection report. This document requires updating to include details of the new manager, correct details of the CSCI and the most recent inspection report. One person confirmed that they received enough information to help them decide to use the service. A pictorial Service Users Guide has been developed, making it more accessible to people who use the service. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 9 The manager said that full assessments are completed before someone moves in. We saw detailed assessments in case files, ensuring people’s needs can be met. The manager said that people are invited to visit before they move in to help them decide if the home is ‘right’ for them, and as a part of the assessment process to ensure the service can meet the individuals needs. We saw details of visits made before someone moved in. 63a Victoria Avenue DS0000007210.V364286.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 and 9 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Staff understand the importance of people being supported to take control of their lives. Care plans could be more person centred, include goals and reference to equality and diversity. Risk assessments are in place and should include more information on the actions staff should take to minimise risks. EVIDENCE: We saw care plans contain information about individuals needs, developed from assessments. We feel care plans could be more person centred including details of what care is required, when the individual wants or needs it and how the care should be given. Care plans and daily records could also be less task focused and include information about how the individual is experiencing the care and support. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 11 Care plans are reviewed every month. The care plans for one person noted ‘no change’ at every monthly review. This may indicate that staff are not detailing small changes. When information is reviewed and changes have occurred, we recommend it be written out again, with the date. Previous records can be archived to keep files up to date with relevant information easily accessible. The manager is aware of the areas that need to improve and is developing a plan to ensure the work is completed. We saw a communication ‘dictionary’ in one person’s file, which detailed the ways the individual communicates. We feel this could be developed further with descriptions or pictures of the signs people use to show how they are feeling. One person said the home ‘always’ meets the needs of their relative. One person said the home ‘always’ gives the care and support needed. We saw risk assessments completed for bathing, fire safety, eating and choking, epilepsy and aids and adaptations. We feel these risk assessments should include details of the actions staff should take, to minimise the risk and protect the person from harm. We saw that risk assessments allow a balance between people having a fulfilling life and safety. 63a Victoria Avenue DS0000007210.V364286.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, 15, 16 and 17 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who use the service take part in a few regular activities and community outings. People who use the service have the opportunity to maintain important family relationships. People are supported to be involved in the domestic routines of the home. EVIDENCE: The manager said that this is an area that they have worked to improve, with people who use the service accessing more community based activities. They plan to continue improving people’s access to community activities over the next year. We saw people go out shopping and to lunch, attending college and watching television during our visit. We feel that more could be done with people on an individual basis to develop and improve the services provided. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 13 We saw an activity record sheet which gives a quick note of the activities and outings people have taken part in. This record for one person had not been completed since the 13th May 2008. The manager and staff said that people are supported to maintain contact with their family. One relative confirmed that they visit the service regularly. People receive a balanced diet with any religious and medical dietary needs catered for. We saw good records of the foods individuals prefer and staff develop the menu from these. We saw records of food provided. Staff said any concerns with weight loss or gain would be reported to the GP and dieticians, to ensure individuals receive appropriate meals to meet their needs. 63a Victoria Avenue DS0000007210.V364286.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 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Personal support is responsive to people’s individual needs and preferences. Staff respect privacy and dignity. People have access to appropriate healthcare services both in the home and in the local community. Medication is well managed. EVIDENCE: The manager said all people are treated with respect and their privacy and dignity is maintained. Two people said the service ‘usually’ respects peoples privacy and dignity. We saw staff speak with people before they moved them or while they were doing an activity. The manager said the people who use the service are registered with a GP and see the dentist in the local community. We saw good records of health care appointments and any issues noted were followed up. The service has links with district nurses, speech and language therapists and dieticians, ensuring peoples healthcare needs can be met. Two people said the care service ‘usually’ meets peoples health needs. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 15 We saw medication appropriately stored and records up to date and signed by staff with one exception. We saw on one Medication Administration Record Sheet that staff had signed for one medication that had not been administered and was still in the blister. This medication was not due to have been given yet. The manager and area manager were aware of the incorrect signing and were dealing with this, including ensuring staff administer the medication at the right time. We saw good notes of when ‘as required’ medications should be given, ensuring staff are able to meet peoples health needs. Ten members of staff have completed training in the administration of medication. 63a Victoria Avenue DS0000007210.V364286.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 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and in pictorial and other formats so it is accessible to the people who live there. Appropriate polices and procedures are in place for safeguarding and staff complete training. EVIDENCE: The manager said the complaints procedure is given to people before they move in. Records are kept of complaints and actions taken although one record does not include a clear outcome. The manager reported that this occurred before he started and had been dealt with. Reference to where the outcome is noted should be included in the complaints record. One relative was not sure if they had been given a copy of the complaints procedure but they were confident about who they would talk with if they had issues. One relative said the service ‘always’ responds appropriately to issues or concerns. Fourteen members of staff have completed training in the protection of vulnerable adults. Three staff are due to complete safeguarding training. We suggest staff complete the local authorities training in safeguarding, so they are familiar with local practice and make links with the appropriate people. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 17 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, 27, 29 and 30 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The environment is generally well maintained and provides specialist aids and equipment to meet people’s needs. The home is a pleasant and safe place to live. Bedrooms are single. All areas are well lit, clean and tidy. EVIDENCE: 63A Victoria Avenue is purpose built two-storey house with specialist aids and adaptations to meet the needs of the people who live there. We saw bedrooms have been personalised or are in the process of being decorated to individuals taste and choice. Communal facilities include a lounge with doors to the garden, a kitchen/dining room and a soft room for relaxation. All areas are accessible to the people who use the service. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 18 The lounge carpet is in need of replacing and the hall carpets need cleaning. The paintwork and doorframes in the hallways are also showing signs of wear and need repainting. We feel communal areas are quite bare and functional. The manager said that they plan to look at making the environment more homely. An adapted bathroom with toilet is available on both floors, both with appropriate aids and adaptations to ensure people can bathe safely with staff support. The manager said that they have a redecoration schedule in place, which has included communal areas being redecorated and this year people’s bedrooms will be painted. We saw all areas of the home to be clean and tidy. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet people’s needs. Staff have access to relevant training. Staff recruitment is in line with regulations. Staff meetings now take place regularly and staff supervision is taking place. EVIDENCE: We saw enough staff to meet the different needs of people who use the service. Staff said they have enough staff to meet people’s needs. One relative said staff ‘always’ have the right skills and experience to look after people properly, adding ‘they get training if anything changes’. We saw some good positive interactions between staff and people who use the service. We feel that this is an area that has improved and could be developed further with training and support for staff. The manager said this is an area that is still being addressed, to improve the care and support provided. The manager said staff are recruited following the organisations policy. This includes requesting two written references, one being from the most current or 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 20 last employer and a Criminal Records Bureau check being completed before the person starts work. We saw application forms, confirmation that a CRB check had been completed, proof of the individuals identity, an induction checklist and supervision notes in staff files. We only saw one written reference in one staff file, with two references in another file. The manager said staff have access to training through the organisation and that all staff have completed or are due to complete NVQ to Level 2 or 3. We saw staff training records confirming that all staff have completed training in food hygiene, medication and epilepsy. Half the staff team have completed training in manual handling and health and safety. Two members of staff have done training in recording and communication. A session of fire safety is booked for all staff to attend. Staff said they have good training opportunities and that any sessions they do are relevant and help them do their job better. The manager said he is seeing all staff during May and June 2008 for supervision and will then see all staff every two months. Staff said they have enough support. We saw records indicate that staff supervision has not been taking place regularly since the last inspection. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The manager understands the principles of the service and is working to improve the care provided, recording practices and activities and outings for people. Appropriate health and safety policies and practices are in place. EVIDENCE: The manager has been at the home for one month and has previous experience working at the home and in a deputy managers position in a similar service. The manager demonstrated a commitment to improving the quality of the service and has developed an action plan to do this. The manager reported that he is due to start NVQ to level 4 and the Registered Managers Award. He needs to apply to register with the CSCI to comply with regulations. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 22 We saw records of two staff meetings in May 2008 with previous minutes July, August and October 2007. The manager said the organisation has a monthly managers meeting, to offer information and support. A representative from the organisation visits the home to check on the quality of the service, to speak with people who live there and see the activities they participate in, to speak with staff and check records. We would like a copy of the report from these visits sent to us, to keep us informed of progress with improving the service. The area manager said that the organisation completes an assessment of the service every year, again looking at the quality of the care and support provided. The last report available was completed in 2006. The manager said that the organisation sends out quality assurance surveys to people who use the service and their relatives or representatives, staff and any other people with an interest in the home. The purpose of this is to find out how people view the service and look at any areas that could be improved. Any suggestions are looked at and used to develop the service. The area manager said the organisation has an annual meeting for service users which includes a type of social activity, this offers people who use the organisations homes in the area the opportunity to request changes, suggest ideas for the future and have some fun. We saw records of these events. The manager said that all health and safety checks are up to date. We saw records confirming this. 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 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 3 26 X 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 YA1 Good Practice Recommendations The Statement of Purpose and Service Users Guide must be updated to reflect the services provided, the manager and changes to the CSCI contact details, to ensure people are fully informed when making the decision to move in. It is recommended that the organisation looks at the care plans in use to see if they can be made more user friendly with all the necessary information in one place. The care plans could better reflect the future goals and aspirations of the people living there. Daily recording could be less tasks focused and include comments about how the person is experiencing the care and support provided. Risk assessments should include the actions for staff to take to minimise risk and protect people from harm. DS0000007210.V364286.R01.S.doc Version 5.2 Page 25 2. YA6 3. 4. YA6 YA6 5. YA9 63a Victoria Avenue 6. YA12 We recommend that the activity record sheet is completed daily to show what activities and outings individuals have participated in. Staff should complete the local authorities safeguarding training so they are aware of local practices and develop links with the appropriate people. We recommend that the carpet in the lounge is replaced and the carpets in the hallways are cleaned. Consideration should also be given to painting doorframes and woodwork in communal areas and hallways, to bring the environment to a good standard. 7. 8. YA23 YA24 63a Victoria Avenue DS0000007210.V364286.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 63a Victoria Avenue DS0000007210.V364286.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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