Care Home: 67-71 Lansdowne Road

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What the care home does well What has improved since the last inspection? There have been and are still ongoing improvements to the environment. The home has employed a maintenance person and cleaner and the home was clean and tidy on the day of inspection. They have implemented comprehensive Person Centred Care Plans, much of which was in an `Easy Read` format and showed that, wherever possible, service users are fully involved with the care planning process. What the care home could do better: The general environment, furnishings and soft furnishings could be further improved to provide a more pleasant environment for both service users and staff. The environment lets down and otherwise good service. There were two good practice recommendations: The Statement of Purpose and Service Users Guide (and the complaints procedure) required updating to include contact details for local Social Services and CSCI. Visitors should be clear where they are to enter the home so that this can be monitored - to maintain the safety of both service users and staff. CARE HOME ADULTS 18-65 67-71 Lansdowne Road Aylestone Leicester Leicestershire LE2 8AS Lead Inspector Mrs Carole Burgess Unannounced Inspection 11th September 2008 10:00 67-71 Lansdowne Road DS0000006412.V371392.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 67-71 Lansdowne Road DS0000006412.V371392.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. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 67-71 Lansdowne Road Address Aylestone Leicester Leicestershire LE2 8AS 0116 283 4025 F/P 0116 283 4025 42.lansdowne@craegmoor.co.uk 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) Lansdowne Road Limited Ms Lesley Wakefield Care Home 28 Category(ies) of Learning disability (28) registration, with number of places 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration apply Date of last inspection 17th October 2007 Brief Description of the Service: 67-71 Lansdowne Road is registered to provide care and accommodation for up to twenty-eight adults with a learning disability. The home is divided into four self-contained units for service users with differing levels of need and ability. The home is situated close to Aylestone Road and is approximately one mile from the city centre. There is a regular bus service to and from the city centre close to the home. A number of shops, parks and a leisure centre are located close by. The Statement of Purpose and Service Users Guide are available (these provide information on how the home is organised and what services they provide). The Statement of Purpose and Service Users Guide are provided for all new service users and are available in an ‘Easy Read’ format. A copy of the most recent inspection report, and an ‘Easy Read’ version are available in each unit. The fees for care and accommodation depend on assessed need. At the time of the site visit the Registered Manager stated that the current fees were between £329.00 and £836.00 per week. 67-71 Lansdowne Road DS0000006412.V371392.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 stars. This means the people who use this service experience good quality outcomes. ‘We’ as it appears throughout the Inspection Report refers to ‘The Commission for Social Care Inspection.’ The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. Planning for the inspection included reviewing the Annual Quality Assurance Assessment (AQAA), which is a self assessment tool completed by a representative of the service, reviewing the previous inspection report, assessing notifications of significant events, any complaints about the service and reviewing the home’s service history to date. The site visit was unannounced and took place over five and a half hours. We selected three service users and tracked the care they received through a review of their records, discussion with them (where possible), other people who use the service, the care staff, and observation of care practices. We spoke with staff members regarding training and support. Prior to the inspection we sent out ‘Have Your Say about 67-71 Lansdowne Road ’ surveys. We received one response from a member of staff and three from service users - completed with the help of relatives or carers. All of the responses were positive about the care and support provided at the home. A relative said that, ‘ Staff members are a big help and always respond when issues arise. I visit daily at different times’. A service user said that they were happy living in the home, and a member of staff said, ‘I am being trained and empowered and equipped so that I become more relevant and useful in my role and in my job’. The Registered Manager and other staff spoken with were positive and helpful during the inspection. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There have been and are still ongoing improvements to the environment. The home has employed a maintenance person and cleaner and the home was clean and tidy on the day of inspection. They have implemented comprehensive Person Centred Care Plans, much of which was in an ‘Easy Read’ format and showed that, wherever possible, service users are fully involved with the care planning process. 67-71 Lansdowne Road DS0000006412.V371392.R01.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. The summary of this inspection report can be made available in other formats on request. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with information about the home, and have their health, welfare and social care needs assessed, so that they can be fully met once they move into the home. EVIDENCE: The home provides prospective service users, and their relatives, with a Statement of Purpose and Service Users Guide (both give information about the home) to help them decide if the home is the right one for them, they were also available in an ‘Easy Read’ format. Signed copies of Terms and Conditions (contracts) were kept in service users’ files. However, the information provided in the Statement of Purpose and Service Users Guide required updating and should include contact details for Social Services and the CSCI so that service users and their relatives, or representatives, have correct and current information. (This should also be updated in the complaints policy and procedure that was included in the Service Users Guide). 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 10 The pre-assessment process and documentation were robust ensuring that service users’ health, welfare, social needs and personal aspirations could be supported once they moved into the home. Service Users’ files contained a comprehensive pre admission assessment and the supporting local authority’s assessment and outline care plan. The assessment included personal details, relative and GP contact numbers, past and present medical history, current health care requirements, medications and a detailed social history. All of this information demonstrated a person centred, and individual approach to care and support. It was also provided within a pictorial format and showed that service users, wherever possible, had been involved with the assessment process. A relative said that, ‘We as a family viewed the home before making the choice’. Both the family and service user said that they were given sufficient information to enable them to choose if the home was the right one form them. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home have their independence promoted and supported, wherever possible, enabling them to make decisions and choices that affect their daily lives. EVIDENCE: Care plans and daily records contained information about the support service users required in their daily lives. The Person Centred Care Plans were detailed and reflective of service users’ specific needs and abilities. Risk assessments had been completed in the service users’ care plans in relation to specific, individual activities and identified the support the service user required. There were regular, minuted, service users’ meetings such as ‘Your Voice’ which followed a set format and showed that service users were consulted 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 12 about different aspects of the running of the home, including activities, meals and health & safety issues. There were detailed risk assessments for the case tracked service users for different activities of daily living, which identify measures to minimise risks and promote service users’ safety whilst supporting a level of independence appropriate to the individual service user’s needs. Service users had been involved in the home’s recruitment process and were part of the interview panel for a new member of staff to ensure that the person would ‘fit in’. A service user spoken with said that she was well supported by staff and that risk assessments and any restrictions imposed were to maintain her safety; that these had been fully discussed and she had signed to say that she agreed with the plan. All responses to the surveys indicated that service users are able to make decisions about how they spend their time during the day, in the evenings and at weekends. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home enjoy, experience and participate in different activities and interests, and are supported to maintain their preferred individual daily routines. EVIDENCE: Service users’ files contained details about their activities and interests. These had been discussed with service users and reflected their specific and individual needs and aspirations. Some service users go to work or college and meet with their friends and have greater independence but all service users can take part in organised activities provided by care staff employed at the home. There was an activities co67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 14 ordinator who ensured that service users were provided with a range of activities. On the day of the site visit a number of service users went out with carers on an open top bus tour of the city. Other recent activities included trips to the park, zoo and seaside and there was a disco on Wednesdays, the service users and staff had also enjoyed visits to the pub, picnics and BBQ’s. Service users said that they enjoyed the food. Menus were flexible to accommodate likes and dislikes and any special diets. Service users said that they liked having ‘take-a-ways’, either fish and chips or Chinese, which they had every week. Staff members were seen to communicate and engaging with service users in a respectful and meaningful way, some using Makaton with service users who had difficulty with verbal communication. A service user said that she and other service users were happy living in the home, and were able to go out and enjoy themselves with their friends. Another service user had a job during the week and said that he liked going to work and would be sad if he was unable to go. There are regular birthday parties at the home, which service users organise and invite other people they want to come. Staff said in the survey that, ‘The service promotes independence and self reliance to service users. The service does encourage the service users to do things on their won for themselves’. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are well supported in respect of their health and personal care. And their independence is promoted by receiving support, when required, in the preferred way. EVIDENCE: At the time of inspection most of the service users were independent in respect of personal care, some requiring prompts; that is they did not require physical assistance with washing, dressing or toileting, although this assistance would be given where required. Service users’ care plans contained details about individual healthcare needs and had been reviewed and updated as required. Visits to and by health professional such as GP’s. District Nurse, the Community Psychiatric Nurse (CPN) and chiropodist were recorded and followed up as necessary. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 16 Care plans also demonstrated that service users were provided with both emotional and healthcare support in respect of their personal relationships. Medication policies and procedures were satisfactory and service users received their medication as prescribed. Medication was stored safely in a locked cupboard and designated staff administer service users medication and receive annual training to ensure that they are safe to do so. On the day of the site visit it was noted that a service user was provided with carer support to visit the local hospital for a check up. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are protected by the complaints policies and procedures, and arrangements for receiving and responding to complaints were satisfactory. EVIDENCE: The CSCI has received one complaint regarding the home since the last inspection. This was returned to the provider and was dealt with through their complaints procedure in a satisfactory manner. The information regarding complaints required updating to include contact details for Social Services and the CSCI (see Choice of Home). All staff receive ‘Safeguarding Vulnerable Adults’ and the home’s policies and procedures reflect the current local Multi Agency Policy & Procedure For The Protection of Vulnerable Adults from Abuse, No Secrets’ publication, of which the home had a copy, to ensure that staff have current guidance on safeguarding vulnerable adults. However, having been invited into the home by a service user and allowed to wander through the home unchallenged, it is recommended that a single point 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 18 of entry is identified to enable staff to vet visitors and ensure that service users and staff remain safe and all times. Two services users spoken with said that they felt very safe living at Lansdowne Road. All service users who responded to the surveys said that they were happy in the home, that staff listened to them and treated them well and that they knew how to complain if they needed to. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 19 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 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although clean the standard of décor in the home remains shabby and requires replacing/upgrading in a number of areas. EVIDENCE: There were concerns identified at previous inspections, and in a complaint made about poor décor and cleanliness throughout the home. Although improvements had been made to the environment and work is ongoing; some areas of the home still had stained carpets and furnishings that required replacing to make the home more comfortable for both service users and staff. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 20 However, the service users’ rooms that were seen looked clean and well personalised and the main communal areas were generally bright and clean The Registered Manager said that things had improved as they now had a regular cleaner and maintenance person. All responses to the surveys indicated that the home was kept clean. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 21 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at the home are sufficient in numbers and receive training to enable them to meet the needs of the service users. EVIDENCE: There were twenty-eight service users at the time of the inspection. Staffing levels, at the point of inspection, were in line with those suggested by the Department of Health Residential Forum Guidelines and were sufficient to meet the current service users’ needs. There were six care staff on duty during the day and two carers and a ‘sleep in’ at night. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 22 Service users said that they felt that there were sufficient staff to care for them. Three staff files were checked during the inspection and showed that there had been a robust recruitment procedure and contained all of the correct checks to ensure the that service users were well protected. The Registered Manager had a training matrix for all staff, which indicated their training needs. New staff undertake a robust induction and foundation programme and mandatory, annual updates in core topics such food hygiene, first aid, medication, health & safety and moving and handling. A member of staff said that the company ensure that staff are provided with good training and that she was about to undertake training in autism and epilepsy. The Registered Manager also said that seventeen of the care staff had National Vocational Qualifications (NVQ’s) in Care and another five people were working towards NVQ’s. Staff were well supervised by the Registered Manager who undertakes regular staff supervision (a review of staff’s personal and training needs in relation to their work). Regular, recorded supervision ensures that staff have their training needs identified. This and the planned training programme ensured that staff had the necessary skills to provide a good care and support for the service users. Staff spoken with said that they received good training and support, including additional training on associated conditions such as epilepsy and autism. The survey from a member of staff stated that, ‘My manager discusses with me regularly on how I am working and highlights where I may not be doing so well and where I am doing well and gives an overview of what is expected and what should happen’. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 23 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 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run in the best interest of service users by a Registered Manager who provides effective, support and guidance to staff. EVIDENCE: The Registered Manager is experienced in caring for people with a learning disability. She has an NVQ in Care, Level 4 and the Registered Managers Award (RMA). There was an ethos of warmth and openness in the home and staff delivered a good standard of care and were well organised. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 24 The service users’ personal allowances were observed being checked by the Registered Manager and care staff. Any ‘caps’ on daily allowances (to help service users manager their own money) were discussed and agreed with the service users and their social worker and were signed as agreed in the care plans. Records of transaction were maintained to show the deposits and withdrawals and were signed by staff and the service user to ensure that the balance was correct. There was a system for quality assurance. There were different ways that the quality of the service was monitored. The views of service users were obtained through various house meetings where service users can say what they think and share ideas. Questionnaires were also given out to service users and relatives. The questionnaires were sent to head office where they were analysed to provide an action plan that is then sent to the Registered Manager to address and make improvements to the service. This is also monitored through the company’s Clinical Governance and audit process. Health and Safety Policies and Procedures, such as regular recorded fire drills, fire alarm tests and regular equipment maintenance had been completed and showed that the Registered Manager was mindful of her responsibilities to make sure that service users and staff live and work in a safe environment. 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 25 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 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 26 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 It is recommended that the Statement of Purpose and Service Users Guide (and the complaints procedure) required updating to include contact details for local Social Services and the CSCI. It is recommended that visitors are clear where they are to enter the home so that this can be monitored to maintain the safety of both service users and staff. 2. YA23 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 67-71 Lansdowne Road DS0000006412.V371392.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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