Care Home: Cardigan Road

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What the care home does well What has improved since the last inspection? Some people who need it are getting extra staff time, so that they can do activities on a one-to-one basis. What the care home could do better: Staff could keep records better, as it was difficult to find up to date information in some care plans, as well as the fire book. Staff could use pictures more often in the information they have on display, like the menus or fire procedures. This would mean that people who find it hard to read can understand what the information says. The house would be better for people if the bathrooms were improved. CARE HOME ADULTS 18-65 Cardigan Road 66 Cardigan Road Leeds West Yorkshire LS6 3BJ Lead Inspector Stevie Allerton Key Unannounced Inspection 6th November 2008 12:30 Cardigan Road DS0000001431.V371906.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 Cardigan Road DS0000001431.V371906.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. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cardigan Road Address 66 Cardigan Road Leeds West Yorkshire LS6 3BJ 0113 2752124 0113 2752124 lorraine.shaw@st-annes.org.uk www.st-annes.org.uk St Anne`s Community Services 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) Mrs Lorraine Shaw Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2006 Brief Description of the Service: Cardigan Road provides accommodation for up to eight men and women who have a learning disability. Nursing care is not provided at the home. It is operated by St. Anne’s Community Services. The home is situated close to the cricket and rugby grounds in Headingley, Leeds. There are shops, pubs, GP surgery, and other amenities within walking distance of the home. The home is well served by public transport and there is parking alongside the garden area at the rear of the building. The accommodation is provided over four floors, the home being accessed by either the lower ground floor at the rear, or steps leading up to the front door. There is a stair lift on the stairs from the lower ground area. Service users have single rooms and one person has a self contained flat. Current charges are from £437.93 70 £601.11 per week. Cardigan Road DS0000001431.V371906.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 the people who use this service experience good quality outcomes. This inspection was carried out without people knowing we were coming and was done by one inspector over the course of one day. Before the visit, we looked at the information we already had about the home was reviewed. This included looking at any notified incidents or accidents and other information passed to CSCI since the last inspection. This information was used to plan this inspection visit. The home completed their Annual Quality Assurance Assessment (AQAA) fully. We did not send surveys out to people living at the home on this occasion. An Expert by Experience joined us in the afternoon. This is a person who does not work at CSCI, but who uses care services herself and knows what it is like. She spoke to 6 of the 8 people who live in the home. She encouraged them to talk about their lives, how they choose what to do and what they like about the place they live. Four people were case tracked, and other files were looked at. Case tracking is how we decide if people receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method, all twenty-one key standards from the Care Homes for Younger Adults National Minimum Standards, plus other standards relevant to the visit, were able to be assessed. We looked at written records, looked round the house and spoke to the staff as well as the people living there. What the service does well: The service is good at responding to peoples needs in a flexible way, so that everyone is treated as an individual. Staff are good at making sure peoples rights are upheld. There are regular house meetings where people can say what they think. People have lots of choice about things – how their home runs, what they eat and what they would like to do. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 6 People get the support they need to lead good lives, where they can learn new things and take part in interesting activities. Staff make sure that people stay healthy and that, if they need tablets, they get them at the right time. Staff get good training to help them do their jobs and managers check up to see that they are doing the right things. 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. Cardigan Road DS0000001431.V371906.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 Cardigan Road DS0000001431.V371906.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): 2&3 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People living at the home continue to be supported according to their assessed needs. EVIDENCE: The service user guide is provided in picture format. There is a person centred approach to care planning, although the care files seen showed that there was different documentation in some of them and different plans in place. There had been no new admissions since the last inspection. We case tracked four people with a wide range of abilities. One person has had extra funding agreed for 12 hours a week to provide one-to-one staff time. Reviews showed that this was working well and had improved the quality of life for this person. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 9 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 & 9 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The system of care planning in place ensures that people’s needs are met and that staff have guidance as to how to support each person. However, because some of the files contained information that was out of date, there is a risk that people may not get the best support. People have the right to make their own decisions; where limitations have been imposed, these have been based on assessed risk and written agreements made where appropriate. This ensures that people’s rights are upheld. EVIDENCE: Care planning documentation was a bit difficult to work through, as each person appears to have two files, one containing correspondence, benefits etc, and one containing the person centred plan, health plan, personal information, Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 10 etc. Alongside these there is also each persons daily file, which includes their daily timetable. Each area of need identified has a corresponding action plan. An example was that one person has one-to-one time with staff, every week for three to four hours, during which he can do whatever activity he would like. There was a very structured daily timetable in place for this person. The support plans, also contained a very good written guidance for staff (“common approaches”), covering social needs, personal care, domestic support or health needs. In instances where staff need to open someones mail in order to reduce their levels of anxiety, this is clearly written down and was an example of good practice. In one file, there was an additional support plan put in place following hospital discharge. However, this was now not needed, and so needed to be removed or condensed into the general personal care support plan. For another person, there is a very structured day, which includes one-to-one staff time. This person is supported in their own semi independent flat situated at basement level. They invite their friends down to watch TV or to share a meal, so do benefit from social contact. Staff say that the system is working out well and there is now less friction with other people living in the house. This was agreed with the multidisciplinary team, to ensure she is not isolated. The expert by experience spent some time talking with this person, who said that before, she had found it difficult “living with the others I didnt like. Now I love where I am.” This persons risk assessments and plans contained lots of alterations and evidence of review, but it was difficult to find out what was current as there was so much information in the file. There were written agreements in place regarding the smoking policy -smoking is now only permitted outside the building. In some files, there was evidence that people had signed that their care plan had been read to them by their key worker. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 11 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 & 17 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People continue to take part in a wide range of opportunities for personal development, including work, which means they lead fulfilling lives. People feel involved in how their home is run. If the use of pictorial symbols was increased, this would aid communication for many people who live in the home. EVIDENCE: People each have a weekly timetable, some of which are very structured in order to meet their needs, and which include taking part in household tasks. There were records of the activities that individuals have taken part in: some of the most recent ones included trips to see the Blackpool lights, trips to shopping centres, attending church, going on holiday, enjoying meals out, the Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 12 cinema, visiting friends, social clubs, and attending the St Annes Service User Forum. Some people are able to go out without staff, while others do need that individual support. Someone has paid employment as a gardener and also attends college courses. Families are invited for Sunday lunch sometimes. The staff rota is organised to allow for support to attend outside events, mainly during the day. However, if the trip is planned in advance, then the rota can be organised to cover escorting people on evening events. The expert by experience spoke to six of the eight people living there. She felt that choice was very noticeable. People said, “I like to go out for a meal, my favourite food is pizza”, “Ive been on holiday to Majorca, we went on the plane.” People confirmed the social activities that they had been attending or were looking forward to, such as a forthcoming trip to London to see a band. They also spoke about their holidays. The expert by experience felt that she would like to see more leaflets on display about things to do and places to go, particularly things that are free, in order to give some new choices and ideas for people. The person living in the flat makes her own breakfast, and all other meals are taken down to her. Other people can help with preparing and cooking meals. Food is shopped for locally. People said “I can buy what I want to eat”, “I help with the cooking, but Im not allowed in the kitchen when there are hot pans”. The list of meals is suggested by people at their house meetings, menus produced weekly and displayed in the kitchen. This is just written, rather than being supported by pictures, unlike the household tasks rota, which has appropriate pictures relevant to the task e.g. vacuuming. Some people do their own laundry and ironing and others have it done by the staff. Peoples views are encouraged and used to help plan the way the service develops. A video has been taken to capture the views of the people living at 66 Cardigan Rd. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 13 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 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The staff team are aware of service users’ changing health needs and respond appropriately by re-assessing and adjusting resources. This means that people get the help they need to meet their health needs. Medication is managed properly, which makes sure that people get the treatment they need at the right time. EVIDENCE: We looked at medication for two people who were case tracked in particular, and others in general. The two people both have drugs that need to be taken a certain length of time before meals, so this was explored. The staff confirmed that the routine of these medications was very important to the people concerned and described their normal practice. This was seen during the late afternoon. One person administers her own medication; there is a written agreement in her care plan file, describing how the staff take her medication to her and Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 14 leave it for her to take. Medication is supplied through Lloyds pharmacy, using a pre-dispensed system. Recording charts were seen and appeared to be completed correctly. A person who was prescribed some anti-anxiety medication to be given PRN (as and when necessary) had been administered some on 2nd November. There was a written report as to why this had to be given. The staff team demonstrated good flexibility regarding the timing of medication, which is good practice. One person has current health problems, entailing regular hospital appointments. The staff support him with this, which could be seen in his records. Another persons health records and health action plan showed the involvement of psychiatric services and medication injections fortnightly in order to maintain his mental well-being. Records showed regular appointments with mental health professionals, six monthly medication reviews with the GP, and a yearly checkup with blood tests etc. Although the resident group is ageing, no one appears to have developed dementia at this stage. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 15 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 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. The training and guidance the staff have access to ensures that they can identify who might be vulnerable and keep people safe. EVIDENCE: Staff have recently had some training and guidance on how to work with people whose behaviour challenges the service, backed up by written guidelines on behaviour management. The complaints procedure is in an easy read version, and people who live at the home say that they feel confident about making a complaint. There are regular house meetings, where people can raise their concerns and talk about them. Staff help people to manage their money. Some people are given a small amount daily, as they spend it all at once. There is a daily check on finances during the staff handover between shifts; this was seen during the inspection. The expert by experience spoke to some people about their money, and found that some people are solely responsible for collecting their benefits at the bank:” I go to the bank, the staff write down how much to ask for. I sign my name in the box when Im there. I bring the money back and the staff put some in the office and some in my purse.” “When I go shopping I make my list Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 16 with the staff. I pay and get a receipt, and give that to the office when I get back”. Cardigan Road DS0000001431.V371906.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 & 30 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People live in a safe, comfortable environment, that is bright and cheerful, and people are proud of their own rooms. The service should plan to upgrade the bathrooms to reflect the increasing age and decreasing mobility of some of the people living there. EVIDENCE: The expert by experience was shown three bedrooms. One person said. “I have the best room in the house. I chose the wall colour. Look at the view, isnt it good?”. The house is well decorated, spacious, and there is room for people to do different things at the same time. The bathroom in the ground floor flat has a walk-in shower, but the bathrooms in the main part of the house need updating. The home appeared to be clean and well maintained. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People are looked after by a staff team that are well trained and supervised. People are protected by the recruitment procedures in place. EVIDENCE: The staff rota was seen: there are two or three staff during the day from 7.00 a.m. until 7:30 p.m., with one member of staff after that. Peoples agreed one-to-one time is assigned on the rota. It has been a long-standing staff team at this service. Three staff left earlier this year, plus there is a new manager. There are now two men on staff team, one of whom transferred from another service within the same organisation, therefore he just had to have an induction to this service. This person will be taking on the fire facilitator role; training has been set up for him to attend. His staff record was seen, which confirmed that he had had a CRB (Criminal Records Bureau) check. We spoke to a member of staff who talked about her key worker role -- liaison about health issues, GP appointments, etc., and liaison with the college her Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 19 key client attends. She also organises her social calendar. She has worked for this organisation for 15 years, at this service for eight years. Recent training has included the Positive Behaviour Support Group, which she found interesting. We spoke to another staff member, who has been here for one year and already has achieved NVQ level 2. She confirmed that her induction training included training on the Protection of Vulnerable Adults (POVA). Recent training has been on epilepsy awareness. She confirmed that she has supervision, approximately every 2 months. Minutes of staff meetings were seen. One of the people living in the house helps with interviewing new staff, which he says he enjoys, as he gets paid for it. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 20 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, 40, 41 & 42 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People benefit from living in a service that is managed well. Some of the written records and policies need streamlining, so that everyone knows they are working with the most up-to-date version. EVIDENCE: The manager has been in post since 1st September, and her application to become registered has been sent to CSCI. The two houses which she is responsible for are in close proximity. The home has an annual plan that links into St Annes larger plan. Equality and diversity have a high profile within the organisation. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 21 Written records were sampled, including care plans, accident records, menus, fridge temperatures, medication records, complaints records, maintenance records, fire records, staff files, minutes of meetings, staff rotas, peoples financial records, and reports of visits made under Regulation 26. Records were reasonably well-organised and accessible. One member of staff has the health and safety lead within the home, and sometimes residents will do the checklists along with her -- records were seen. The six monthly fire training was due in October, and the manager had already asked the person with the fire lead to obtain the training DVD from the training department. The last recorded fire drill was in early August, which took place with everyone who lives there and 2 staff. Not all fire drills and incidents are recorded in the appropriate place; for example, there was a noted incident in one persons file on 2nd November in which they set the fire alarm off. A fire drill was carried out, but this was not recorded in the fire record book. It was also noted that there are two separate fire evacuation plans, which say different things. Policies and procedures do need to be gone through, to make sure that only the most up-to-date version is available for staff. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 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 3 25 3 26 X 27 2 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 2 3 x 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 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 4 2 2 3 X Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 23 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. 1 Standard YA6 Regulation 15 Requirement Care plans must reflect the current support issues for people, and out of date material must be archived. This is so that staff are working with the most up-to-date instructions and guidance as to how to support each person. Fire records must be accurate and contain details of all fire incidents, practices and drills. Timescale for action 31/03/09 2 YA41 17 Schedule 4 31/01/09 3 YA40 17 Schedule 4 This is so that it can be demonstrated that people living in the home and the staff working there know what the procedures are in the event of a fire. The fire procedure must be up to 31/01/09 date and reflect current guidance & practice. Out of date procedures must all be removed. This is so that everyone follows the same procedure in order to remain safe. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 24 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 2 Refer to Standard YA17 YA27 Good Practice Recommendations Greater use of pictorial symbols, particularly for the menus, would improve communication and help people to make choices independently. Bathrooms would benefit from upgrading in the near future, to give people more choice and flexibility. Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Cardigan Road DS0000001431.V371906.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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