Care Home: Hitchin Road (9)

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What the care home does well The residents generally appeared well cared for. They have limited communication skills but members of staff interacted well with them using the individual`s preferred mode of communication. There is a competent staff team who are knowledgeable about the individual needs of people using the service and they support, empower and enable them in their daily living skills. Care plans are `person centred` and reviewed on a regular basis to address the changing needs of people using the service. These are comprehensive and show how personal and healthcare needs are being met. The environment is well maintained and a good standard of cleanliness was evident throughout those areas viewed. The systems in operation including complaints and safeguarding adults should offer adequate protection to people using the service. In relation to equality and diversity, the home has a `Resident`s Charter` in which it specify how individual`s privacy, dignity, independence, choice, rights must be respected. The home also has a policy in place and staff spoken to were aware of and ensured that people were treated equally irrespective of their age, race, disability, religious beliefs, cultural background and sexual orientation. What has improved since the last inspection? Since the last inspection all care staff have now had refresher`s training in the administration and management off medicines. New lighting in the hallway by the lift has now been fitted to provide adequate light. New carpets have been fitted to two of the bedrooms and the lounge. New menu has been devised with pictorials to be added on. People using the service are now accessing `Peoples First Group` advocacy meetings. CARE HOME ADULTS 18-65 Hitchin Road (9) 9 Hitchin Road Stevenage Hertfordshire SG1 3BJ Lead Inspector Bijayraj Ramkhelawon Unannounced Inspection 3rd June 2008 10:00 Hitchin Road (9) DS0000019431.V364879.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 Hitchin Road (9) DS0000019431.V364879.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. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hitchin Road (9) Address 9 Hitchin Road Stevenage Hertfordshire SG1 3BJ 01438 352 395 01438 742 865 hitchin@lot-uk.org.uk lifeopportunitiestrust.co.uk www.lifeopportunitiestr Life Opportunities Trust 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) Manager post vacant Care Home 7 Category(ies) of Learning disability over 65 years of age (7), registration, with number Physical disability over 65 years of age (7) of places Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration category will revert back exclusively to `Old Age` for service users over 65 with learning and physical disabilities once the two named service users with dementia permanently leave the home for any reason. 10th December 2007 Date of last inspection Brief Description of the Service: No.9 Hitchin Road is a residential care home provided by Life Opportunities Trust, a charitable organisation. The home is registered for 7 elderly people with learning and/or physical disabilities. It is situated in Stevenage on a busy trunk road leading to the A1(M) and Hitchin. There are parking spaces in the front of the building. Transportation is provided for service users by means of a specially adapted minibus. The Edwardian building was renovated to provide seven single bedrooms, 2 on the ground floor and 5 on the first floor. There is a passenger lift to the upper floor. The two assisted bathrooms and toilet facilities are nearby. The communal space includes a family style lounge that overlooks the back garden and a large dining room with interconnecting hatch to a well-equipped kitchen. A tracking hoist is fitted to the main lounge, the bedrooms, bathrooms and toilets. The administrative office and the laundry room are all on the ground floor. To the rear of the building is a large and attractive garden with mature trees and plants. There are comfortable garden furniture and seating for service users. The garden is accessible to wheelchair users. The home charges from £1226 - £1368 per week. Information about the home and the service it offers is contained in the ‘Statement of Purpose’ and ‘Service User’s Guide’. A copy of these and the most recent CSCI inspection report are available on request from the home. Hitchin Road (9) DS0000019431.V364879.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 unannounced key inspection was carried out on the 3rd of June 2008 and took one whole day. It included talking to people using the service and staff, examining care plans, staff files, staff training records, fire safety procedures, maintenance records, all other records and documents and a tour of the premises. The home has not completed an Annual Quality Assurance Assessment (AQAA). Feedback received from people using the service was very positive. They said that they are happy with the support they received and that their rooms were nice, the food is good and the staff were caring and supportive. One resident said ‘ I like it here. It is nice and the staff are good to me’. What the service does well: The residents generally appeared well cared for. They have limited communication skills but members of staff interacted well with them using the individual’s preferred mode of communication. There is a competent staff team who are knowledgeable about the individual needs of people using the service and they support, empower and enable them in their daily living skills. Care plans are ‘person centred’ and reviewed on a regular basis to address the changing needs of people using the service. These are comprehensive and show how personal and healthcare needs are being met. The environment is well maintained and a good standard of cleanliness was evident throughout those areas viewed. The systems in operation including complaints and safeguarding adults should offer adequate protection to people using the service. In relation to equality and diversity, the home has a ‘Resident’s Charter’ in which it specify how individual’s privacy, dignity, independence, choice, rights must be respected. The home also has a policy in place and staff spoken to were aware of and ensured that people were treated equally irrespective of their age, race, disability, religious beliefs, cultural background and sexual orientation. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 6 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. Hitchin Road (9) DS0000019431.V364879.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 Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People choosing to use the service can be assured that information about the home would be available to them so that they could make an informed choice and that their assessed needs would be met. EVIDENCE: Information about the home was available to current and prospective individuals including the ‘Statement of Purpose’ and ‘Service User’s Guide’. However, the ‘Service User’s Guide’ had not been reviewed and updated. It still contained the old address and contact details of the NCSC and not CSCI. Care plans examined and information gained from people using the service and members of staff indicated that individuals were admitted to the home after an assessment of needs has been carried out. However, the forms that are used for the assessment of needs were seen for newly admitted residents did not state their names nor there was section provided for this information to be included. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 9 Records examined and information gained from staff and people using the service demonstrate that normally individuals admitted to the home are under a Care Management arrangement and have a full assessment of needs carried out by their respective Social Worker, prior to admission to the home. People using the service and staff spoken to confirmed that prospective residents, their relatives/friends are always encouraged to visit and to “test drive” the home. If a placement is offered and accepted, the initial visits to the home is followed by a trial period to allow for staff to carry out a full assessment of needs. At the end of the trial period, a review meeting is held with all concerned, in order to consider if a long term placement is appropriate or not. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 - 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that their identified needs would be met appropriately and that they would be enabled to live the lifestyle they chose. EVIDENCE: People using the service spoken to said staff supported them in making choices about their clothes they want to wear, food and activities they wish to do and participate in. Members of staff were observed to interact well with them and communicated with the residents in a manner that was appropriate to their level of understanding using a combination of verbal communication and gestures so that the residents could understand. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 11 Care plans examined show that these were drawn up from a range of sources including individual’s assessment of needs, reports from Social Workers, input from family representatives, staff’s on going assessment during the trial period and contributions from other professional as appropriate. Care plans were detailed and comprehensive which reflected the identified needs of people using the service and how these needs were being met. Regular review of individual’s care needs was also carried out and details of their changing needs were reflected in their care plans. Staff members spoken to demonstrated a good knowledge of the needs of individuals. Care practice observed appeared to empower people using the service and their rights to decision-making were also being proactively encouraged and upheld, as appropriate. Up to date risk assessments were in place covering a wide range of activities. Evidence gathered suggests that staff treated information given by people using the service and significant others in confidence. Records regarding the residents are compiled and stored in accordance with the organisation’s written procedures and the Data Protection Act 1998, and in their best interests. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that they would have opportunities for personal development and enhanced their daily living skills so that they are able to lead as near normal a life as possible. EVIDENCE: A weekly activity programme was devised for each individual as part of the care plan. Details of social history, interest and hobbies were reflected in each person’s care plan. Those who are able were actively encouraged to continue with any activity or hobby they were involved in, prior to their admission to the home. This includes indoors and community based activities as well as attending the other leisure and social activities arranged for them during the evenings and weekends. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 13 Individuals spoken to said that they received support from members of staff in facilitating to access indoors and outdoor activities. The home has a vehicle that is used for transporting people for outdoor activities and appointments. A variety of social and recreational activities are facilitated to people using the service including leisure interests. People using the service are encouraged to develop and maintain social, emotional, communication and independent living skills where appropriate. Information gained from staff, residents and examination of care plans and menus indicates that people using the service and their relatives are consulted regarding residents’ culinary likes and dislikes. Residents expressed satisfaction with respect to food available to them. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that their personal and healthcare needs would be met appropriately. EVIDENCE: Three residents spoken to during the inspection said that they were being well looked after and cared for. Members of staff were knowledgeable of the residents’ conditions, their likes and dislikes, and delivered care and support accordingly. Individuals received personal and healthcare support using the ‘person centred’ with support provided based upon identified needs including the rights of dignity, privacy, choices and respect. Care plans examined show that people using the service are registered with a General Practitioner and they are able to see their doctor at the surgery. Healthcare needs were being met by healthcare professionals and a record of their visits was kept as part of the care plan. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 15 The administration and management of medicines has improved considerably since the report of the last key inspection. There are regular audits and checks undertaken to ensure that safe administration of medicines is in practice. The records for ordering, administration, storage and disposal of medicines are kept in good order. All staff who administer medicines have undergone the safe administration and management of medicines training and those spoken to said that they have a robust system in place now to ensure that medicines are administered and managed safely. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that their concerns and complaints would be listened to and acted upon and that they would be safeguarded from abuse, neglect and harm. EVIDENCE: The home has a complaints procedure which is also included in the ‘Service Users’ Guide and ‘Statement of Purpose’. Residents spoken to said that they would speak to members of staff or their key workers if they had any concerns or complaints. The home maintains a record of complaints and none has been received since the last inspection. The home has a copy of the Hertfordshire procedures on safeguarding adults. Staff spoken to confirmed that they are familiar with the procedures and staff records showed that they have received training on the safeguarding adults. An element of adult protection is also covered in the induction programme for all new staff members and those people undertaking the NVQ assessment. Hitchin Road (9) DS0000019431.V364879.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, 26 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are cared for in an environment that is homely, comfortable and safe. EVIDENCE: The home was well maintained and furnished in a domestic style to provide a very homely, comfortable and safe environment. All bedrooms viewed were painted in different colours chosen by individual residents and personalised to reflect the tastes of the occupants with pictures and personal belongings displayed in their individual room. Staff members reported and residents spoken with confirmed that they are consulted about the décor. However, there are residents who looked after their own money who was not provided with a lockable space in their bedrooms so that they can keep their money and valuables safely. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 18 A good standard of cleanliness was evident throughout those areas viewed. Food items were appropriately stored in fridges and temperatures, recorded daily. The home has an infection control policy and procedures in place and staff encourage residents to follow good hygiene practice. Staff members spoken to are conversant with infection control procedures. Since the last inspection, new lighting by the lift has been fitted. New carpets in two of the bedrooms and in the lounge have also been fitted. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 - 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service do benefit from the care and support they receive from a competent and qualified staff team and that they feel protected by the home’s recruitment policy and practices. EVIDENCE: Information gained from duty roster and staff members provides evidence that the day and night staffing levels remain adequate to meet the needs of current residents. Staff members have the necessary skills and they receive appropriate training to meet the varying needs of people using the service. Staff spoken with indicated that they have excellent opportunities for relevant training and this gives them greater confidence to do their jobs. Staff were knowledgeable about the needs of individuals whom they were supporting and caring for. Currently, 14 care staff have completed their NVQ Level 2 and the manager is Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 20 currently undertaking NVQ Level 4. This represents 78 of the care staff have successfully completed the required NVQ Level and above. The procedures for the recruitment of staff were found to be robust. The recruitment files for 4 members of staff, two of whom have recently been employed were examined. These were found to be in good order. The two new members of staff were currently progressing through their induction programme and undertaking the mandatory training. Five members of care staff were spoken to and they all confirmed that they had their CRB checks carried out prior to an offer of employment was made. Staff spoken to confirmed that they received one to one formal supervision on a regular basis. Supervision records were maintained. Staff also confirmed that they received support from the management team and that senior members of staff were approachable and available for advice as and when needed. Since the last inspection care staff have attended refresher in-house training in the administration and management of medicines and have also attend training in Mental Capacity Act 2005. Ongoing rolling programme for mandatory and other relevant areas has been planned for this year. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be assured that their health, safety and welfare are protected by the systems and practices in place and the support they receive from a dedicated staff team. EVIDENCE: The home is well managed and staff spoken to confirmed that the manager is approachable and they are bale to raise any issues or concerns they may have. People using the service have commented positively on the good practices and quality of service provision. One said ‘ I like it here. Staff are nice. Food is good and my room is nice too’. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 22 The effective implementation of a number of systems including assessment and admission process, care planning and review, consultation and communication, recruitment, induction, training, supervision and appraisal of staff ensures that the home operates in an efficient manner; this clearly benefits people using the service and the staff teams. The home has a quality assurance system in place and seek the views of people using the service, relatives, staff and other interested parties. All statutory records were available for inspection and maintained in accordance with legislation. Records inspected were up-to-date and accurate and were held securely. Staff spoken to were aware that people using the service can access their records and information held about them in accordance with the Data Protection Act 1998. There were policies and procedures in place to ensure that the health, safety and welfare of people using the service and staff are promoted and protected. These records were accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms have been completed where applicable. CSCI has been kept informed of all accidents and admissions to hospital. Regular checks on hot water temperatures and moving and handling equipment were recorded. A valid insurance certificate (expires on 30/09/08) was displayed in the office and this offered cover of no less than £5 million. Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 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 3 3 x Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA1 YA2 YA26 Good Practice Recommendations The ‘Service User’s Guide’ should be reviewed and updated to include the correct contact details of the Commission. Assessment forms should be formatted to include residents names. Lockable space for safe keeping of valuables and money for residents should be provided in their bedrooms.’ Hitchin Road (9) DS0000019431.V364879.R01.S.doc Version 5.2 Page 25 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 Hitchin Road (9) DS0000019431.V364879.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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