Care Home: Riverside Close, 8

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What the care home does well The overall findings of the inspection were good. Riverside Close is a small home which works on the principles of ordinary community living. The service is provided to meet the needs of people who have autism and as such routines and activities are planned with the specific needs of the people living in the home in mind. Each of the people living at the home has a care plan and these describe the support needs of the person. Guidelines are in place for staff to know how to support people with particular issues which they find difficult. People living at the home are supported to use the local community and to pursue interests outside of the home. They are also well supported in using and developing their daily living skills such as personal care, cooking, shopping and housework. People living at the home are well supported to remain healthy and staff have a good level of information on the people`s health needs and are supporting them to attend health appointments on a regular basis. The staff team is stable and staff appear to have built good relationships with the people living at the home and to have gained a good understanding of their needs. Staff carry out regular safety checks so that people living at the home are provided with a safe place to live. What has improved since the last inspection? Staff have been provided with further training since the last inspection. This has included training in first aid, fire safety, adult protection, moving and handling, infection control and supporting people who have autism. There have been some improvements to the presentation of the home and some redecoration. Staff meetings are taking place on a more regular basis. This provides staff with a regular chance to talk about the needs of the people living at the home and to look at ways in which to improve the service. The home now has a manager who is registered as manager with CSCI. What the care home could do better: Information on staff recruitment needs to be available so as to show that the people living at the home are protected from potential abuse. An appropriately detailed policy and procedure with regards to money paid by people living at the home to staff must be in place, and followed by staff, so as to safeguard people. CARE HOME ADULTS 18-65 Riverside Close, 8 8 Riverside Close Bootle Liverpool Merseyside L20 4QG Lead Inspector Debbie Corcoran Key Unannounced Inspection 28th November 2007 2:30 Riverside Close, 8 DS0000005240.V343557.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 Riverside Close, 8 DS0000005240.V343557.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. Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Close, 8 Address 8 Riverside Close Bootle Liverpool Merseyside L20 4QG 0151 944 2716 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.peterhouseschool.org Autism Initiatives Alan O’Leary Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 3 LD. Date of last inspection 30th June 2006 Brief Description of the Service: 8 Riverside Close is a small home registered for three people with a learning disability. The service is provided by Autism Initiatives and the registered Landlord for the property is Riverside Housing Association. Autism Initiatives was formerly called the Liverpool and Lancashire Autistic Society and it was established in 1971. The organisation provides a variety of services to adults and children who have autism. These include residential care, day care, supported tenancies, outreach, domiciliary care, respite and educational services. Autism Initiatives is a voluntary organisation with charitable status. 8 Riverside Close is a four bedroom house which is located in a residential area in Seaforth, Merseyside. The home is a domestic property which promotes the principles of ordinary community living. The home has good transport links. Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit to the home was not announced beforehand. During the visit two of the people living at the home were met. The manager and another member of the staff team were spoken with. Care plans, staff training records, health and safety records and other relevant records were examined in some detail. A tour of the home was carried out which included a sample of bedrooms. The manager of the home returned a quality assurance assessment to CSCI prior to this the visit and some of the information in this has been used to inform the inspection. What the service does well: The overall findings of the inspection were good. Riverside Close is a small home which works on the principles of ordinary community living. The service is provided to meet the needs of people who have autism and as such routines and activities are planned with the specific needs of the people living in the home in mind. Each of the people living at the home has a care plan and these describe the support needs of the person. Guidelines are in place for staff to know how to support people with particular issues which they find difficult. People living at the home are supported to use the local community and to pursue interests outside of the home. They are also well supported in using and developing their daily living skills such as personal care, cooking, shopping and housework. People living at the home are well supported to remain healthy and staff have a good level of information on the people’s health needs and are supporting them to attend health appointments on a regular basis. The staff team is stable and staff appear to have built good relationships with the people living at the home and to have gained a good understanding of their needs. Staff carry out regular safety checks so that people living at the home are provided with a safe place to live. Riverside Close, 8 DS0000005240.V343557.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. Riverside Close, 8 DS0000005240.V343557.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 Riverside Close, 8 DS0000005240.V343557.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information on the services and facilities provided at the home is available for people to make an informed choice about moving to the home. Systems are in place for ensuring the needs of people referred to the service are assessed before they move into the home. EVIDENCE: A statement of purpose, which describes the services offered by the home, is available and this provides the people living at the home and new people with information as to the services provided. A service users guide is also in place. This should be produced in formats suitable to the needs of the people using the service. There have been no new people to the home since the last inspection visit. Therefore the assessment and referrals processes could not be practically assessed. Autism Initiatives do have assessment and referral policies and procedures to be used when a new person is referred to the home. These detail that an assessment of the person’s needs is carried out prior to the person moving in to the home. The assessment format is good and allows for the recording of information that is specific to the needs of people who have autism. Riverside Close, 8 DS0000005240.V343557.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, 9Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is detailed information on how to meet the needs of the people living at the home. People living at the home are consulted with on a constant basis and participate in decision making about the home. People are supported to take risks as part of living an independent lifestyle. EVIDENCE: The records for one of the people living at the home were looked at in order to assess care planning. These records showed that there are detailed guidelines on how to support people living at the home. These guidelines cover a whole range of issues such as the persons likes / dislikes, support with managing difficult situations, support with routines, support with social interaction and with issues very specific to the needs of the individual. The level of information in these was comprehensive and they provide a good guide for staff in how to support people and they promote consistency in how support is provided. Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 10 Each person also has a support plan which describes goals for their personal development and how to support the person with these. For example support plans may include information on supporting a person to develop their independent living skills and they focus on specific tasks. Support plans are monitored on a monthly basis. The person whose care planning was looked at had just had a full review of their support. The review involved a meeting with relevant others and included a representative from Social Services. Care planning information describes the preferences and daily routines of the people living at the home in a great level of detail and people are encouraged and supported to make their own decisions and to participate in the decision making in the home. Staff were observed to be regularly consulting with residents throughout the visit. Risk assessments are carried out in relation to the support provided to each of the people living at the home and these were viewed. The risk assessments identify potential hazards to the person’s safety and well being and include detailed guidelines as to how to then manage the risk or prevent the risk from occurring. The risk assessments cover different aspects of the persons support. For example support with communication or with community access. The risk assessments are comprehensive and are reviewed regularly. Riverside Close, 8 DS0000005240.V343557.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): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are supported with their personal development and supported to pursue social and leisure activities and use the local community. People living at the home are encouraged to choose their food, to eat a health balance diet and to cook their meals. EVIDENCE: Support plans guide staff in supporting people who live in the home to learn and develop new skills. The support plans also ensure that staff work consistently in supporting people to achieve new skills and to monitor progress in meeting targets and moving on to develop further skills. Support plans are monitored on a regular basis and new plans are introduced once the person has learned the skills of established plans. Discussions with people living at the home and observations during the visit confirmed that they are well supported to use their skills. People living at the Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 12 home were observed to be cooking their own meals and carrying out household tasks. There are comprehensive ‘guidelines’ describing the needs of each of the people living at the home. These include information on activities which the person likes to be involved in and includes information on the person’s social and recreational needs. People are supported to use community resources independently were they have the skills to do this and there was an example whereby one of the people living at the home has been supported to increase their skills in this. Activities are arranged around the individual needs of the people living at the home. People living at the home are supported in developing and maintaining relationships. This has been confirmed during discussions with people living at the home. People are encouraged to develop and maintain relationships through work placements, social groups and in using community facilities. Records relating to people living at the home include information on the people who are important to them and include contact details for their relatives, friends and relevant others. Staff communication well with relatives of the people living at the home and promote regular contact. In assessing the diet and meals available to people living at the home menu records were looked at and the availability and storage of food was checked. These indicated that the people living at the home have a good choice and variety of food and meals. People living at the home are being encouraged to make choices of meals and food and this was observed in interactions between people living at the home and staff. People living at the home are encouraged to use and develop their skills in shopping for food and preparing and cooking food. Riverside Close, 8 DS0000005240.V343557.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are well supported with their health and physical care needs and with their emotional well-being. People living at the home are protected by staff following policies and procedures for the safe administration of medication. EVIDENCE: Guidelines are in place for each person living at the home regarding how to meet the person’s personal care needs, physical care needs and health care needs. Guidelines also include a good level of information on the individual’s likes and dislikes and preferred routines. Detailed guidelines are available to guide staff on how to support people with their emotional well being. When appropriate records include guidelines for support with specific activities. For example there may be detailed guidelines for supporting a person when they are out and about in the community or if they have difficulty in managing social interactions. Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 14 Discussions with staff and observations of staff supporting the people living at the home indicated that staff have a good level of understanding of the emotional and psychological needs of the people living at the home and work consistently in supporting individuals. People living at the home are supported to visit a General Practitioner or district nurse when this is required and are supported to visit a dentist, optician etc on a regular basis. This information is well documented. Policies and procedures are in place for the receipt, storage, administration and disposal of medications. Medication administration records were checked for one of the people living at the home and these were found to be appropriate. People living at the home are encouraged to maintain and administer their own medication based upon a risk assessment and risk management. Staff are provided with training in the safe administration of medication. Riverside Close, 8 DS0000005240.V343557.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff respond to the views and wishes of people living at the home and policies, procedures and practices are in place for dealing with complaints and for aiming to protect service users against abuse or neglect. EVIDENCE: Staff appear to know the needs of the people living at the home well and the way in which they described supporting people on a very individual basis indicates that they are aware of people’s needs and choices and listen and act upon these. The home has a complaints procedure which is time scaled appropriately. The statement of purpose and service user guide for the home include information on how to make a complaint and give an overview of how complaints are dealt with. There have been no complaints made since the last inspection visit and therefore how complaints are managed could not be practically assessed on this occasion. Autism Initiatives has a ‘service user protection document’. This provides a guideline for staff on how to deal with a potential adult abuse allegation. The majority of staff have been provided with adult protection training. Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 16 The home has a ‘whistle blowing policy’ the purpose of which is to protect staff who identify and report allegations of abuse. The home has further policies and procedures aimed at protecting people who use the service and these include a physical intervention policy and a management of service users money policy. The way in which the money of one of the people using the service is managed was looked at. People living at the home are requested to pay members of staff for travel purposes if they use the staff’s own transport. This agreement is not appropriately formalised in a policy and procedure and is not appropriately audited to ensure that people living at the home and staff are not left in a vulnerable position. The procedures are not sufficiently detailed and in addition to this there was an example noted whereby staff had not implemented the procedures appropriately. This leaves people living at the home and staff in a vulnerable position. The manager must ensure that staff are aware of their responsibilities in accounting for monies. This should be linked into developing the policy and procedure for staff expenses incurred when supporting people living at the home. This was discussed with the manager both during and following the inspection visit. Requirements have been given for this to be addressed but these have not been met. A repeat requirement has therefore been given. A record of key events is maintained for example incident reports and accident reports. These were checked and found to be maintained appropriately and there were no areas of concern identified. Riverside Close, 8 DS0000005240.V343557.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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, comfortable, safe and presented to a satisfactory standard. EVIDENCE: The home is in keeping with others in the area and is an ordinary domestic property. The home has a lounge and dining room and therefore people living at the home have use of a private room if they so wish. There have been a number of improvements to the home environment since the previous inspection. This includes some redecoration of communal areas and one of the bedrooms, refurbishment of the dinning room and refurbishment of the kitchen. The home has health and safety practices and procedures which are aimed at ensuring the home is safe and clean and as free from hazards to the health and safety of service users and staff. Riverside Close, 8 DS0000005240.V343557.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, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are supported by appropriately trained staff. It could not be determined that staff recruitment and selection practices aim to protect people as information to demonstrate this was not available. EVIDENCE: The manager has carried out an audit of staff training to ensure that all staff have up to date training. Staff are provided with training as appropriate to meet the needs of the people living at the home. Staff training includes training on topics such as first aid, fire safety, adult protection, moving and handling, infection control and supporting people who have autism. 2 out of the four members of staff on the team have attained a National Vocational Qualification (N.V.Q) in care. Discussions with members of the staff team and observations of them interacting with people living at the home indicated that staff are supporting the aims and objectives of the home in encouraging the people to make choices, learn new skills and use their local community. Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 19 There have been two new member of staff since the last inspection. The recruitment and selection procedures used when employing these members of staff could not be assessed on this occasion, as the records, or confirmation that appropriate records had been attained, had not been provided to the manager from the central office. The manager must ensure that evidence of appropriate staff recruitment and selection procedures are available at the home so as to demonstrate that procedures protect people living at the home. The manager has recently introduced staff supervision meetings and records showed that team meetings are taking place on a regular basis. These provide staff members with a regular forum to discuss issues that may affect the service provided to people living at the home and the implementation of polices, procedures and practices within the home. Riverside Close, 8 DS0000005240.V343557.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, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the people living there. The quality of the service is checked on a regular basis. Policies, procedures and practices are in place to safeguard the safety and well being of people living in the home and staff. EVIDENCE: A new manager has been appointed to the home since the last key inspection. The manager has since registered as manager with the Commission. The home appears to be run in the best interests of the people living at the home. There is a quality assurance process at the home which includes regular visits and audits from a representative employed by Autism Initiatives. Quality assurance has not included surveying the people living at the home for a Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 21 number of years. It is recommended that surveys are carried out and that the findings of these are linked to an annual development plan. Staff are provided with training in health and safety topics and the home has health and safety policies and procedures. Fire safety and health and safety practices are adopted. Records of fire and health and safety checks were checked and found to be up to date. Riverside Close, 8 DS0000005240.V343557.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 3 2 3 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 4 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 YA23 Regulation 13 (6) Requirement An appropriately detailed policy and procedure with regards to money paid by people living at the home to staff must be in place, and followed by staff, so as to safeguard people. Evidence of appropriate staff recruitment and selection procedures must be available at the home so as to demonstrate that these procedures protect people living at the home. Timescale for action 28/12/07 2. YA34 17 (2) schedule 2 28/12/07 Riverside Close, 8 DS0000005240.V343557.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. Refer to Standard YA37 Good Practice Recommendations The quality assurance process at the home should include surveying residents on the quality of the service provided and feedback from this should be used to inform an annual development plan. Riverside Close, 8 DS0000005240.V343557.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Merseyside Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Riverside Close, 8 DS0000005240.V343557.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. 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