Care Home: Heathcotes Oadby

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What the care home does well The care plans thoroughly describe the care that the resident needs, what activities the resident likes and wishes to do and how these are to be achieved. The staff call the residents by the name that they prefer, support them in making decisions about their lives and treat them with dignity and respect whilst giving them privacy. `Staff are good`. The residents live in a comfortable and safe environment and have bedrooms that are personal to them and their needs. `I like my room` The staff receive excellent training to make sure that they can support the residents with their specific needs and disabilities. The staff always recognise peoples` different needs including cultural and spiritual and enabled them to continue with them. The home maintains good communication with the relatives of the residents. This was confirmed in the care plans when there had been communication between them. What has improved since the last inspection? This was the first inspection of a new home. What the care home could do better: The complaints policy could be updated to include the updated details for the Commission for Social Care Inspection and the details for Social Services. They could make sure that all educational opportunities are explored for the residents. CARE HOME ADULTS 18-65 Heathcotes Oadby 103 Foxhunter Drive Oadby Leicester LE2 5FE Lead Inspector Thea Richards Unannounced Inspection 17th November 2008 15:15 Heathcotes Oadby DS0000072214.V373062.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 Heathcotes Oadby DS0000072214.V373062.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. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathcotes Oadby Address 103 Foxhunter Drive Oadby Leicester LE2 5FE 01162713955 01162710331 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) www.heathcotes.net Heathcotes Care Ltd Katherine Morgan Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code 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 - Code LD The maximum number of service users who can be accommodated is 6 2. Date of last inspection New Service Brief Description of the Service: Heathcotes is a converted house registered to provide care for six people with a learning disability. The home is owned by the Heathcotes group and has been managed by Katherine Morgan since it opened, who is a knowledgeable and caring manager. It is situated in Foxhunter Drive close to the centre of Oadby in Leicester. It is close to local amenities and can be reached by both public and private transport. There is parking available to the front of the house and in the road at the front of the house. The home has bedrooms on the ground and first floors, all of which have ensuite facilities. In addition there is a bathroom on the first floor and ‘wet room’ on the ground floor. There is a communal lounge and a dining room on the ground floor with an activity room and a relaxation room on the first floor. There is a well- equipped kitchen and a laundry room on the ground floor. The stairs reaches the first floor. Outside is a pleasant, well -maintained garden with a patio area that will have tables and chairs in the better weather. The home has its own transport to take the residents to the day centre and to Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 5 other activities. The home can be contacted by telephone, fax or email. The weekly fees are negotiated on an individual basis according to the residents’ needs. The registration certificate from the Commission for Social Care Inspection, an up to date certificate of insurance were displayed in the entrance hall and the latest inspection report will be made available. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. There is an‘ easy read’ summary included with this report. The Quality rating for this service is 2 Star. This means that the people who use this service experience good quality outcomes. This was a key inspection of a care home for people with a learning disability, which ended with an unannounced visit to the service. Before the visit we (throughout the report the use of ‘we’ indicates the Commission for Social Care Inspection), spent four hours reviewing information received by the Commission for Social Care Inspection (CSCI) since the homes registration on 7th July 2008. The visit took place on the 17th of November 2008 and lasted four hours. During the visit we checked all the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called ‘case tracking’. Case tracking means that we looked at the care provided to two of the residents. To achieve this we spoke with the staff supporting their care and looked at the records relating to their health and welfare. We spoke with the residents although some of the communication was difficult; we managed to get feedback from them. With their permission, the residents’ bedrooms were looked at. We also checked how the home was run and organised. This included looking at staff records, training and how the staff are organised. We looked at health and safety records, menus, minutes of meetings and the quality audit. The policy for handling complaints and how the home dealt with them was looked at. We looked at how prospective residents and their families are given information about the services the home can offer and whether they are suitable for them. We looked at the surveys that had been returned to from the residents and the staff that were found to be very positive about the care and support in the home. During the visit we spoke with the manager, the staff, the residents and the family of a prospective resident. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 7 What the service does well: 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. Heathcotes Oadby DS0000072214.V373062.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 Heathcotes Oadby DS0000072214.V373062.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 excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents have a very thorough admission process and have the information to make sure that the home is suitable for them. EVIDENCE: All of the residents who were ‘case tracked’ had been given a Statement of Purpose and terms and conditions. The Statement of Purpose and Service Users’ Guide is available in other formats such as large print and an easy read style, which we saw. Providing a comprehensive Statement of Purpose & Service Users’ Guide results in good information for the residents, making sure that they they can find the most suitable care. The manager always visits prospective residents before they are admitted to the home and there is a thorough pre admission assessment form in place. This was seen in the care plans looked at and confirmed by the manger and the owner. The admission process included visits to the prospective resident, phased visits to the home and introduction to the existing residents. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 10 Members of the staff spoken with said that they always knew what the residents’ needs were before they moved in. The current registration certificate from the Commission for Social Care Inspection (CSCI) and an up to date certificate of insurance was displayed in the entrance hall. The inspection report from CSCI will be available to prospective residents. Heathcotes Oadby DS0000072214.V373062.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 excellent This judgement has been made using available evidence including a visit to this service. The residents are supported in maintaining their independence and in making decisions in their daily living, giving them a good quality of life. EVIDENCE: The care plans and records looked at contained thorough information about how the residents needs were identified and their choices made. Some of the residents in the home have communication difficulties and the staff have developed different individual methods of communicating using Makaton, words, noises and gestures. The staff were seen to be communicating with the residents with patience, gestures and speech. The care plans have all the information that is needed and describe each individual residents’ needs and wishes. It is clear that the residents have been involved in developing their care plans, which they confirmed when speaking with them. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 12 The staff, with the residents have developed ‘person centred’ care plans in an ‘easy read’ format that describe the needs, choices and wants of the individual. This helps the resident to understand what they have planned with their key worker. Key workers are members of staff who have particular responsibility and interest in an individual resident. They make sure that they have all that they need and that they have the activities and work or education needs met. Whilst it can be difficult to communicate with some of the residents, those that we spoke with on the day of the visit were able to communicate with speech, facial expression and/or gestures. There are risk assessments in place where there may be a risk to the resident either in an activity or in the environment. This allows the staff and the resident to be aware of the possible risk and protects them whilst allowing the resident to continue with the activity. The residents have regular meetings to discuss choices in the home such as activities and menus, but the residents and the staff make choices on a daily basis. This was seen on the day of the visit when a variety of meals and activities were being chosen. Heathcotes Oadby DS0000072214.V373062.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): 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff support the residents in maintaining their interest in their different activities and occupations and make sure that their nutritional and spiritual needs are met. EVIDENCE: There was evidence of daily occupation and leisure activity being provided for the residents. Some of the residents went out on a daily basis to day care or work related activity. One of the residents received a variety of day care in the home that included shopping and cooking, and craft and outings and eating out. There was an individual programme of activities in each care plan including activities in the evenings. The residents are part of the local community, visiting local pubs, restaurants, shops and parks. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 14 The home is still investigating educational opportunities for the residents in the area and this will help in furthering their independence and work activity. The staff were seen to be treating all of the residents as individuals and recognised their different personalities and behavioural needs.. Happy here one of the residents told us. The surveys sent to us all said that the staff were good and that the home fulfilled their needs. The activities are recorded in well documented care plans which are regularly reviewed as the residents needs change. T he choice of food is good and the residents have choices every day. Meal times are flexible to suit the needs and the activities of the residents. They are encouraged to all eat together in the dining room, but may choose to have their meals where they wish to. They were seen to be helping with laying the table and helping with the food in the kitchen. Religious activity is arranged for those residents who wish it. Heathcotes Oadby DS0000072214.V373062.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff meet the care needs of the residents safely, with a complete knowledge of their needs and how they wish to receive them. EVIDENCE: The ‘case tracked care plans were found to have good descriptions of the care needs of the residents. This includes a regular assessment of the residents’ weight and their nutritional needs. There are records of the involvement of G.P.s, chiropodist, optician and dentist present, giving evidence of thorough health care being provided for the residents. Person centred care plans have been developed so that it was clear how each individual wanted to be treated. The staff and the records confirmed that the residents received good medical care when they needed it. The daily record of care is up to date and comprehensive, which makes sure that the residents receive the right care and the staff know what has happened to them during the day or night. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 16 Medication records for the case tracked residents were in order. The staff spoken with were knowledgeable about the medicines and where to obtain information. They were aware of the requirements for the receipt, storage and disposal of medicines. Medicines are stored in a locked cupboard in the home. There is a regular audit of the medicines and record sheets completed by the manager. The above makes sure that the residents are protected with the correct medicine administration. The staff were seen to be administering medicines safely and correctly. There are no residents responsible for their own medicines. All of the personal care needs and medication are included in a separate health booklet that is easily accessible for hospital or medical staff. Heathcotes Oadby DS0000072214.V373062.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place to support and protect the residents and staff are aware of the processes. EVIDENCE: There is a complaints policy in place which gives the details of how to complain and who to complain to if the residents or their families needed to. This needs to be updated to give both the Social Services contact details and the updated Commission for Social Care Inspection (CSCI) details. This can be produced iother formats such as large print and an easy read’ style. We were shown it in the ‘easy read’ style. There have been no complaints received by the home, since it was registered on the 7th July 2008. The CSCI have received no complaints since this date. The staff spoken with were aware of how to handle a complaint if they received one. One of the residents spoken with was able to tell us how he would complain and that he thought that it would be acted on. The staff receive training in safeguarding adults from abuse and are given a copy of the General Social Care Council (GSCC) code of practice, which tells them what their responsibilities are in making sure that the residents are kept safe. Training is given during their induction period. The manager, the records seen and the staff spoken with confirmed that they had had training. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 18 The staff were able to explain to us what forms of abuse there were and how they would deal with it. Heathcotes Oadby DS0000072214.V373062.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents are protected by the policies and procedures in the home to provide a safe, clean, well furnished and equipped environment to live in. EVIDENCE: Heathcotes is a converted house close to the centre of Oadby, Leicestershire. The home was clean and welcoming with a feeling of light and space. It was well decorated and comfortably furnished. The communal bathroom upstairs and the ‘wet room’ downstairs were found to be clean and free from any hazards. With their permission we looked at the case tracked resident’s bedrooms. They provided good accommodation, which had been decorated to the residents’ choice. They were personalised with the resident’s belongings and the residents spoken with told us and indicated by speech, facial expression and gestures that they could have their bedrooms how they wanted them. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 20 I like my room’ All of the bedrooms have en-suite facilities, those upstairs include a shower. There is alarge lounge and a dining room on the ground floor that were bright and well decorated and furnished. Upstairs there is an activity room and a relaxation room, these are both well equipped and provide extra space for group and individual activity. There is a kitchen and a laundry that are well equipped and are used by the residents with help. The staff spoken with had received health and safety training and were aware of how to handle chemicals. These were all stored in a locked cupboard. The fire records for testing and drills was up to date. The water temperatures had not been tested, but all radiators had temperature controls on them. The manager said that she would start checking them as the valves could fail and put the resident at risk of being scalded. There were no outstanding safety or maintenance issues noted on the tour of the premises. There was a large, pleasant, well -maintained garden with a patio area outside and there are plans to buy garden furniture in the better weather for the residents to enjoy. The registration certificate from the Commission for Social Care Inspection (CSCI) and a current insurance certificate were displayed in the entrance hall. The inspection reports from the CSCI will be made available. Heathcotes Oadby DS0000072214.V373062.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. The recruitment and training of staff make sure that the residents are protected from harm and that their needs are met. EVIDENCE: We looked at two staff files and all of the required information was complete in them. This included evidence of identification, adequately completed application forms, two written references, Criminal Records Bureau and protection of vulnerable adults (POVA first)checks. Staff spoken with confirmed that they had not started work until all the paperwork was complete. The home has a thorough induction programme in place for new members of staff that includes the specialist needs of this client group. This is basedon the common induction programme from ‘Skills for Care’ This gives new staff good knowledge for caring for the residents. The manager told us that all of the staff will be enrooled on the National Vocational Award at level 2 as soon as they are out of their probation periods. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 22 The National Vocational Qualification is a qualification for care staff to make sure that they receive appropriate training in the needs of the resident group whom they are caring for. Records show that the staff have had training on many subjects relevant to their work. Staff members spoken with were happy with the amount of training that they were given by the home. This included mandatory training such as POVA, infection control, moving and handling, first aid, food hygiene, control of sustances hazardous to health (COSHH) and fire. Training relevant to the client group that they are caring for is also given. There was evidence in the records that was confirmed by manager and the staff that regular staff supervision was taking place. This process gives the staff and their ‘line manager’ the opportunity to have individual discussions about work and training needs. Heathcotes Oadby DS0000072214.V373062.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live their lives as they would wish to, with individual care being given in a safe environment. EVIDENCE: The manager of the home has managed the home since it opened, is completing a degree in autism and has completed several courses for the specific needs of her residents. She has recently been registered with the Commission for Social Care Inspection(CSCI) as the Registered Manager and is very committed to the care of the residents and the training of the staff. The owners of the home have many years experience in the care for this client group. Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 24 The residents and their parents have regular meetings with the manager when their views are discussed and areas such as meals and activities are decided. The manager sees the residents individually every day when she is on duty. The manager will be giving the residents and their families a quality questionnaire every year, which looks at all the areas of care and the general opinion of the home. The surveys received by us were positive that there was good communication in the home and that the residents were very happy with all aspects of the home. Heathcotes Oadby DS0000072214.V373062.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 4 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 4 25 3 26 X 27 4 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 3 12 2 13 3 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 3 X Heathcotes Oadby DS0000072214.V373062.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? New Service STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. 2. Refer to Standard OP12 OP23 Good Practice Recommendations That the manager makes sure that efforts are made to identify appropriate educational activity is found for the residents. That the contact details are included in the complaints policy and that those of the Commission for Social Care Inspection are updated. Heathcotes Oadby DS0000072214.V373062.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 Heathcotes Oadby DS0000072214.V373062.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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