Care Home: Trevarna

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Stallcombe House
• Belma
• Hunters Care Centre

What the care home does well Cornwall Care as a company have established sound and comprehensive policies and procedures which aim to ensure those in their care are fully protected with their needs being met. Dementia Care training is given high priority. Recruitment procedures are robustly adhered to with all the required checks being made. What has improved since the last inspection? Considerable improvements have been made since the last inspection five months ago. A permanent manager is now in post and she, with the backing of Cornwall Care, has brought some much needed structure to the home. All of the Statutory requirements listed in the last report have been achieved. Record keeping is now up to date and in line with regulatory requirements. This includes review of care plans, fire training and supervision of staff. Night staff numbers have been increased to provide a better service to residents and improve their working conditions. Secondary dispensing of medication at night has ceased and only those staff trained in the administration of medication are involved in the drug rounds. The call bell system in the home has been modified allowing quicker response times. Staff informed us that they had noted improvement and were optimistic of continued positive progress. CARE HOMES FOR OLDER PEOPLE Trevarna 4 Carlyon Road St Austell Cornwall PL25 4LD Lead Inspector Mike Dennis Unannounced Inspection 14th January 2008 10:00 X10015.doc Version 1.40 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 Trevarna DS0000009242.V353424.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 Older People. 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. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trevarna Address 4 Carlyon Road St Austell Cornwall PL25 4LD 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) 01726 75066 mail@cornwallcare.org Cornwall Care Limited Vacant Care Home 54 Category(ies) of Dementia - over 65 years of age (46), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (46), Old age, not falling within any other category (8) Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To include two service users under the age of 65 yrs for respite care only Total number of service users not to exceed a maximum of 54 Date of last inspection 20th August 2007 Brief Description of the Service: Trevarna is a purpose built care home situated close to the residential centre of St. Austell with the local library next door. The home provides residential care for up to 54 elderly people, including up to thirty with a dementia. Accommodation is provided on one floor and service users can access all areas` easily. The building consists of five wings, each having a sitting room, dining room, kitchenette and bedrooms. Meals are prepared in a large kitchen and served in the dining rooms of each wing. Assisted bathing facilities are provided and all rooms have call bells. The home has a hairdressing salon, which is well utilised by service users. There is also a day care facility at the home providing a service for up to twelve elderly people with a dementia. The grounds are kept tidy and there are patios with bench seating. Ramps provide easy access for service users. There is adequate car parking space at the front of the home. There are opportunities for socialising and visitors are openly encouraged. The fees currently charged range from £419 to £600 per week. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and was conducted as follows. Two inspectors, Mr. Michael Dennis and Mr. Alan Pitts visited the home at 9am on Monday 14th.January 2008 and remained on the premises for approximately seven hours. Mr. Dennis returned to the home on Tuesday 15th.January 2008 to complete the inspection. The total amount of inspection time allocated was approximately 17 hours. The purpose of the inspection was to follow up the provider’s compliance with the requirements and recommendations set in the last inspection report dated 20th.August 2007. We focused on the key national minimum standards as identified by the commission. The methods used were discussion with the manager, staff, residents, and their relatives and visitors, inspection of records and documents, observation of the daily life of the home and inspection of the premises. A Short Observational Framework of Inspection tool was also used to enable us to observe resident interactions with staff. We are grateful to the Management team, staff and residents for their assistance in completing the inspection. A new manager, Ms. Kath Cock, was appointed in September 2007. She is currently applying to the CSCI to become the Registered Manager. In the short time that she has been in post considerable improvement to the service provided has been achieved. The last inspection conducted in August 2007 resulted in a number of statutory requirements being made. Cornwall Care has acted promptly to redress these deficits. All the requirements and recommendations have been met. We used, as part of the inspection, a short observational tool (SOFI) to determine the wellbeing of residents and the frequency and quality of interaction with the staff on duty. The results of this exercise are most encouraging. Two SOFI’s were conducted, one in the morning and one in the afternoon involving different residents and staff. The overall average result indicated that approximately 85 of residents observed were in a positive state of wellbeing. None were observed to be in a negative state. A few were asleep or dozing. Residents were seen to have contact and interaction with staff for at least 50 of the time frames and all contact was observed to be positive. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 7 The continuity records will benefit from better inclusion of detail concerning the social and emotional side of residents’ life at the home. Where hand written entries are made on the Medication Administration Records, these need to be witnessed by two signatures. As stated in this report, considerable progress has been made in complying with previous requirements and bringing records up to date. It will now be important to maintain the momentum and further build on progress made. 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. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive the information they require in order to make an informed choice about residing at Trevarna and their needs are assessed so that they can be assured that the home can provide the care required. EVIDENCE: A comprehensive Statement of Purpose and Service User Guide is available. These documents are up to date and relevant for the service currently being provided at Trevarna. We were told that additional staff were being recruited and that an application to change the registration criteria of the home has been made. In the light of this information, it will be necessary to produce an amended statement of purpose. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 10 It was noted that, in some cases, complaints procedures still referred to the CSCI address as being at St.Austell. Any reference to the CSCI should reflect the Ashburton address. Residents informed us that they had knowledge of these documents. A copy of these documents is to be found in each residents bedroom. Five residents files were inspected and case tracked. All contained information pertaining to pre-admission assessment. The information provided included :continence assessment, pain assessment, risk assessments and general details of daily care requirements, medication and health care requirements. Residents files contained signed contracts/ terms and conditions of the home. Residents and relatives confirmed they had knowledge of these documents and processes. Relatives informed the inspector they were able to visit the home prior to admission of their relative. The home caters for those suffering from dementia and staff receive relevant training to a good standard. Intermediate Care is not provided at this home. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal and social care needs are set out in individual plans of care which are regularly reviewed and amended. Medication procedures are appropriately followed EVIDENCE: Five Individual Plans of Care were inspected. They were seen to contain full and relevant information, to include Risk Assessments, pertaining to the health, personal and social care needs of that individual. In addition information is gathered regarding the service users past life experiences and interests. This information will be used to promote an Active Care programme for that individual. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 12 The last inspection report stated that not all of these care plans had been reviewed at monthly intervals as required. The new management team have addressed this deficit and we are now able to report that all care plans are reviewed on a monthly basis. Perceived problems and resident needs were documented along with the action or interventions needed for improvements that would benefit the individual resident. The daily continuity records contain information concerning personal care, accidents, state of mood and other general comments. Good recording practices are in place. Staff should be encouraged to pay a little more attention to recording events of a social and emotional aspect. Nevertheless, positive improvement is noted in this area. Continence assessments have taken place in partnership with the Community Nurses and again improvement is noted in this area of care. Appropriate professionals from other disciplines frequently visit the home to provide for general health care, ie. G.P’s, Community Nurses, Opticians, Dentists etc. Residents have the opportunity to receive aromatherapy and massage. This service is offered on a regular basis. The previous report levelled criticism concerning the competence of night staff administering medication. All night staff have or are receiving accredited training in the administration of medication. Management ensure that if night medication is required then a suitably competent and trained member of staff is available. We inspected the medication records and procedures and are pleased to note that all was found to be satisfactory. On occasion hand written entries to the medication administration records (MAR) were not supported by two signatures. We observed staff treating residents with respect, addressing them in a polite and friendly way whilst respecting dignity and privacy. Residents and relatives confirmed that this was the case. Following analysis of the Short Observation Framework for Inspection (SOFI) exercises, we are able to report positive results. All staff contact with residents was seen as positive. The state of being of those residents observed showed that none were passive or withdrawn and approximately 85 of the time there was positive interactions. Two SOFI exercises were conducted, one in the morning and one in the afternoon. Different groups of residents and staff were observed. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 13 We consider that good progress has been made concerning this group of standards. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to follow a lifestyle, which accords as far as possible with their own choices and preferences. The diet provided is varied and nutritious with attention to individual preferences. EVIDENCE: The residents individual care plan has a detailed section regarding their interests and choice, and activities are planned to encompass these interests. The home arranges and facilitates visiting entertainment and in-house activities. Life story books are being collated to enable social profiling and active care. Planned activities are displayed on a notice board. Flexibility is achieved throughout all aspects of daily living. The management ‘buy in’ facilitators for aromatherapy, hand massage, drama therapy, ‘pat a dog’ etc. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 15 Residents are given the opportunity to vote at elections and evidence was presented to demonstrate that some residents had had contact with solicitors and advocates. Relatives, residents and staff gave examples of the lifestyle, interests etc. relating to individual residents. We spoke with one of the two cooks and evidenced that they were well experienced and qualified. A variety of choices and menus are available on a day to day basis and in some cases special/individualised diets are catered for. Residents confirmed that the food presented was to a high standard and that it met with their approval. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. There are arrangements to protect service users from abuse. EVIDENCE: A comprehensive complaints policy and procedure is kept within the home. This procedure includes timescales and who will deal with the complaint. The home also keeps a complaints log for ease of reference. Residents indicated that they were aware of the procedures. The home has a comprehensive policy and procedure in place to protect residents from abuse. Policies are also available in regard to physical and / or verbal aggression from residents, physical intervention and restraint. Staff are made aware of these procedures during the induction period. The manager is also aware of the local social services procedure within “No Secrets” to investigate any complaints regarding the suspected abuse of any service user. CRB and POVA checks are undertaken, with Cornwall Care being the umbrella body to obtain these checks. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained and provides a safe environment. The premises are clean and hygienic providing a pleasant environment and reducing risks to residents. EVIDENCE: Residents have access to safe and comfortable communal facilities. A program of redecoration and refurbishment is ongoing. Sufficient and suitable lavatories and washing facilities are provided in each area. Sluicing facilities are available. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 18 Bedrooms are suitable for purpose and all individually personalised by the occupant. Residents expressed satisfaction with their living accommodation. Some staff were enthusiastic with the improvements already made and those planned. The home was generally free from offensive odours, clean and hygienic. A carpet cleaning record is kept. This record indicated that a total 28 areas of carpets had been cleaned in the last 7 days alone. This evidence suggests that staff are working hard to promote a hygienic environment. Seating areas are arranged in the gardens with one area designated to become a sensory garden. During the second day of the inspection a pre-arranged consultative meeting was held to discuss the formulation of the sensory garden. The participants included residents and relatives from the home. Overall the premises present to a good standard. The call bell system in Wing one was deemed to be unsatisfactory at the last inspection. The problem has now been rectified and the call bell system throughout the home is working correctly. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures support and protect the service users. Staff are trained and competent to meet the needs of residents. The staffing levels are generally satisfactory. EVIDENCE: The duty rota indicates that 7 care staff are on duty during the mornings, 6 throughout the afternoon and evenings. Waking night staff number 4. In addition managers, domestic and catering staff are on duty. This represents a small decrease in day staff cover. The manager explained that there were currently 5 staff on sick leave. Due to the fact that resident numbers are slightly down at present, she felt that the day staffing ratios were satisfactory. Several of the staff did however mention that they thought the home was short staffed. The night staff have been increased from 3 to 4 waking night staff which is considered a positive move. Staff recruitment is conducted in line with the home’s policies and procedures. Evidence obtained from staff files indicates that references, CRB and POVA checks are taken up prior to interview. All staff undertake Induction Training. . Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 20 NVQ training is encouraged. At present the number of staff holding NVQ certificates has increased to approximately 54.3 . Individual training profiles for staff are kept. All staff have recently received supervision. Staff told us that the regularity of their supervision has improved. Trevarna is applying for nursing status. This will require a revision of the staffing structure. A Lead Nurse has been appointed and 4 other nurses are being recruited in preparation of the anticipated changes. Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33,34, 35, 36, 37, 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider has appointed an experienced and qualified manager who maintains the care delivery to meet the homes stated purpose and objectives. The health and safety of residents and staff is promoted. EVIDENCE: The manager is newly appointed, having been in post since the 3rd.September 2007. Kathryn Cock is a qualified Mental Health Nurse. She has 10 years post registration experience with older adults with functional mental health problems and over 12 years experience of working with dementia clients. She Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 22 is currently supported by the acting deputy manager, an assistant manager and two care coordinators. There are clear lines of accountability from the manager through the other senior staff, who each have specific areas of responsibility. Staff were positive about the support and supervision that they received from the manager. Residents felt that the Manager would listen to and address any concerns that they might have. Cornwall Care Ltd has corporate policies for the management of residents’ monies and the home provides safekeeping for small amounts of money. Each resident has a record detailing payments in and out, and a running balance, with receipts for all expenditures. Each resident’s balance is not held as an individual amount of cash as this would amount to a large sum for the home to hold. The money is held in a specific bank account with a float available for daily transactions. A separate cash book details all payments in and out of the cash float. The administrator has systems in place for checking and reconciling the amount of cash, the bank account balance, and the individual resident’s recorded balances. The staff records showed that staff received supervision sessions, some as individual sessions and some as small group wing meetings. Each member of the senior staff team is responsible for supervising a number of staff. The frequency of supervision has not consistently achieved the six sessions a year recommended in the standard. Since the new manager has been in post this important area of work has improved and this target is within grasp. Staff were satisfied that informal and formal supervision supported them to do their jobs well. Cornwall Care Ltd has comprehensive policies for health and safety. Staff have attended relevant health and safety training. Staff reported that Cornwall Care Ltd promotes safe working and manages health and safety well. The accident record for both residents and staff was inspected. Completed accident records were seen to be kept on the individual residents file. The records showed weekly tests of the fire alarm system and the emergency lighting and regular fire training for all staff. There is a written fire plan. The home’s fire risk assessment has been completed. Trevarna DS0000009242.V353424.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 Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? None 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 OP9 Regulation 13 Requirement Ensure that two staff witness and sign the MAR record when making hand written entries Timescale for action 01/03/08 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 OP1 Good Practice Recommendations It will be necessary to amend the Statement of Purpose within the home as soon as Nursing registration is approved. Where reference to the CSCI in the Statement of Purpose is made, ensure the address of the Ashburton office is included. Continuity records will benefit from more information concerning the social and emotional lives of residents. 2. OP1 3 OP7 Trevarna DS0000009242.V353424.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Trevarna DS0000009242.V353424.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!