Care Home: Westgate

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What the care home does well The service provides a caring environment for residents who have a range of complex mental health needs. Residents are cared for by a staff team who are committed to the work that they do. The staff help to make the Home a safe and supportive place for residents. One resident said, `the staff are all very nice they talk to you and help you `, another comment made was, `it`s a very nice home`, and, `the comfort at the Home is very good it`s excellent `. What has improved since the last inspection? The Home has invested in an ongoing training programme for all staff .The training package includes a range of training for staff to undertake on matters directly relevant to the work they do and the needs of residents.The staff have now done training on Safeguarding Adults to ensure that they understand what is expected of them should an issue arise. What the care home could do better: The Home needs an appropriate metal cabinet for the storage of controlled drugs and other medicines that have to be stored in the same way. Action should be taken so that the bedroom ceiling identified does not have a stain on it. CARE HOME ADULTS 18-65 Westgate Westgate 5 Ellenborough Crescent Weston Super Mare North Somerset BS23 1XL Lead Inspector Melanie Edwards Key Unannounced Inspection 12 November 2007 09:40 Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 1 Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 2 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 Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 3 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. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Name of service Westgate Address Westgate 5 Ellenborough Crescent Weston Super Mare North Somerset BS23 1XL 01934 621952 NONE i.hallscott@btinternet.com 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) Mr Iain Hall-Scott Mrs Jacqueline Hall-Scott Mr Iain Hall-Scott Mrs Jacqueline Hall-Scott Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (10) Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 5 SERVICE INFORMATION Conditions of registration: Date of last inspection 26 April 2007 Brief Description of the Service: Westgate is a Victorian terraced building located within easy reach of the town centre and local amenities. The home offers care to older service users with enduring mental health issues. The weekly fee for the home is £413.02. The Home provides care and support for up to six people with long-term mental health needs. The day-to-day manager lives on site and offers extra support to residents 24 hours a day. The Home is a three-storey building conveniently placed close to the centre of Weston Super Mare and is close to local amenities, and the shops. There are ten bedrooms, two communal living areas, three bathrooms and three toilets. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Seven of the nine residents who live at the Home spoke to the Inspector during the inspection. Mr Iain Hall-Scott (who was on leave, and was out of the country) spoke to the Inspector by telephone. Two members of staff including the day-to-day manager (who runs the Home in the absence of the owner/managers) were consulted about roles and responsibilities, training needs, and how they support residents. Staff were observed supporting residents with their needs. A selection of records relating to the running and management of the Home were inspected. Two resident’s assessment records and care plans were reviewed. The majority of the environment was seen. The only area not viewed was one bedroom. The Home was operating within required conditions of registration set down by us. The conditions of registration detail the type of care and the needs of residents the Home can provide personal care for. What the service does well: What has improved since the last inspection? The Home has invested in an ongoing training programme for all staff .The training package includes a range of training for staff to undertake on matters directly relevant to the work they do and the needs of residents. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 7 The staff have now done training on Safeguarding Adults to ensure that they understand what is expected of them should an issue arise. 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. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3. Quality in this outcome area is good. Residents’ needs are assessed and are met by the Home. The necessary information is available to help people to understand the service provided by the Home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To find out how residents, and prospective residents can find out about the Home a copy of the service users guide was reviewed. The guide includes information about the service provided, the qualifications of the staff employed, and the accommodation. The philosophy of the Home and how the service aim to meet residents needs was also included. A copy of the complaints procedure is also available to all residents. A copy of the statement of purpose was also read. The statement of purpose set out all of the relevant information about how the Home is run. This includes the staffing levels, and staffing structure as well as the type of care that will be provided. To find out how well residents’ needs have been assessed two assessment records were looked at. There are assessments of the physical, mental health and social needs of each resident. There was information recorded about the resident’s views of their care. Included in the assessments were the likes and Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 10 dislikes of the resident, and their preferred choice of social and therapeutic activities. There was information in the assessments that demonstrated they had been regularly evaluated and updated with the involvement of residents. This helps to demonstrate residents’ needs are monitored by the Home. To find out how well the Home is meeting residents needs two care plans were reviewed (see standard 6). There was helpful information written for each resident clearly stating how to assist residents with their mental health needs. The staff conveyed in discussion and by observations that they have a good understanding of the mental heath needs of residents. Staff were observed supporting residents in a kind and friendly manner. This helps to demonstrate that residents are well supported by staff. All of the residents consulted were positive about the Home and the staff. One resident said, `the staff help me’, and another resident said, `they look after us very well ’. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. Quality in this outcome area is good. Residents’ needs are assessed and care plans show how needs are met. Residents are well supported to make decisions and to take risks in their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: To find out how well residents are being supported to meet their needs two care plans were inspected. There was information about the personal history of the resident, and about their physical and mental health needs. There was also a plan of care for each resident that aimed to address the physical, mental, and social needs of the person. The care plans aimed to promote the independence of the resident in their daily lives. There was evidence written in the records that showed residents had been consulted in planning how their needs would be met. There was evidence that care plans had been evaluated and updated on a regular basis with the involvement of the residents. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 12 Residents talked about feeling well supported to go into the community, to go shopping, and to do things that interest them. Residents said that staff are very supportive and will either go with them if they want, or encourage them to be more independent. One resident explained that they like to go into the local town on their own to go to the local charity shops. There were risk assessment records for residents that showed any risks to residents. The assessment records set out how to support residents to maintain their safety, and minimise any risks to themselves or others. There was information written in residents records that showed staff support the residents to maintain their independence in their daily lives, yet still be able to take some risks in the choices they make. In discussion with staff it is clear that one of the aims of the Home is to promote residents’ rights and independence in their daily lives. Residents were observed leaving the Home independently. This is a good example of residents being supported to take risks as part of an independent life style. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,16,17. Quality in this outcome area is good. Residents are well supported to take part in a range of appropriate activities. Residents are supported to be a part of the community and to have personal relationships. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the residents the Inspector met talked about the different day-to-day activities that they like to do. Four residents go to different day service activities that they enjoy. One resident said they did an exercise group, another resident said they often go swimming and may be going to a yoga group. Other residents said that they like to go shopping, into town, and going out together. Two residents were observed going out together during the inspection. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 14 There was information in the care records that demonstrated residents regularly go to different community activities, including the shops, and different social drop in events. There are local facilities for residents to use in Weston Super Mare. Residents go out with staff, or sometimes on their own on a regular basis. The staff on duty explained that the Home aim to support residents to take part in social and therapeutic activities as independently as they can. There are occasional residents meetings held for residents to share their views about the day to day running of the Home. Two residents explained that they have different chores allocated to them. One resident said that their job was to clear away the dishes after meals. The resident said they like having jobs to do around the house, as they like to keep busy. The inspector joined the residents at their invitation, for lunch .The meal was pasties, beans, peas, and home made chips, or cold meats with the same vegetables. The meal was served `farmhouse’ style and residents help themselves .The meal was tasty and well cooked. Residents said that the food at the Home was, `very good ’. The menu record of residents’ meal choices was reviewed to see if residents are provided with a varied and well balanced diet. There was evidence that residents choices were nutritionally well balanced, and varied. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good . Residents are being supported with their needs in the way preferred by them, and their needs are being met. Residents ’ medication is being administered and disposed of safely. However current storage for controlled medication is inadequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was information in residents daily records that shows that the staff monitor and observe the health of residents and call the doctor, if they are concerned about the person. A Psychiatrist and their team support residents with their mental health needs. There was information seen in residents care records from the psychiatrist, who gives advice and support to residents when needed. There are care reviews held involving residents, staff from the Home and the psychiatrist and team. A meeting was due to take place the day after the inspection with the psychiatrist, and the resident concerned to review their mental health care. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 16 All residents are registered with local GP Practices, to support them with their physical health needs. Residents were observed getting up at different times during the morning .All the residents said that the routines in the Home are very relaxed. There was information written in the care records about the preferred day-today routine of the residents and particular likes and dislikes. This helps ensure residents’ needs are met in the way that is preferred by them. The staff were familiar with the information in care plans, and how best to support residents with their care needs. The procedures for the administration, storage and disposal of medication were reviewed to monitor if there safe systems in place. All staff who give out residents medication do regular training to make sure that they do this safely. Medication to be dispensed was stored in a locked wall mounted cabinet in the kitchen. However currently the Home does not have a controlled drugs cupboard. This must be a locked metal cupboard, and is for the storage of controlled drugs and certain other medicines including some sedatives. The medication administration charts of three residents were reviewed. The charts were up to date, legible and contained the signature of the member of staff dispensing the medication, as well as the reasons for any omissions. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is good. Residents are satisfactorily protected from the risk of abuse or harm and abuse. Residents’ views will be listened to and acted upon by the Home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints record book was reviewed to find out how effectively Mr and Mrs Hall-Scott respond to complaints. There had been no complaints made since the last inspection. However all of the residents said that if they did have a complaint they could speak to Mr or Mrs Hall-Scott who would deal with their complaints satisfactorily. Mr and Mrs Hall-Scott see residents on a regular basis. Residents said they make time for them to discuss their needs and if they have any particular issues or matters that concern them. This is a good way to support people to make complaints if they so wish. There are procedures and guidance information on the topic of ‘ the protection of vulnerable adults from abuse ’. This helps to protect vulnerable adults who live at the Home if staff have the necessary information to ensure their protection. Each member of staff has done training to help them better understand issues around the protection of vulnerable adults from abuse. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 18 This training is beneficial as it makes staff have a better understanding of what abuse is, and should protect residents as a result. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30. Quality in this outcome area is adequate. Residents live in a Home that is generally suitable for their needs and lifestyles and promotes their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 20 Westgate an older building in a quiet residential area in Weston Super Mare. It is close to local shops, the sea front, and a train station. Residents said they regularly use the local amenities. The Home was clean tidy and satisfactorily maintained in the majority of areas that were viewed. However one bedroom-ceiling wall has a dark stain on part of the ceiling. Action should be taken to remove this to enhance the appearance of the room for the resident occupying it. Up to date service records were seen for the boiler, and for all of the electrical equipment. This helps to demonstrate that the Home is safe for residents. There is a lounge, and a dining room for residents to use. This is beneficial as this helps ensure residents can maintain their privacy and personal space if they so wish. Residents looked relaxed and comfortable in their surroundings. There is a house cat that residents are clearly very fond of. The bedrooms have been made more homely with resident’s personal possessions. There are wardrobes, a comfortable chair, a bedside cabinet and a chest of drawers in each room. There are also photographs, and pictures displayed in some rooms. There were also resident’s artworks on display in their rooms and throughout the Home. The bedrooms do not have en-suite facilities however there are toilets, and a shower or bathroom near bedrooms on each floor, which is convenient for residents use. The kitchen is on the ground floor. There is a laundry room next to the kitchen. It contains a washing machine and one tumble dryer. Residents use the laundry to wash their own clothes with staff support if needed. This is a good way for residents to maintain independence in their daily living activities. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36. Quality in this outcome area is good. Residents are supported by a sufficient number of qualified staff. Staff are well supported and supervised in their work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 22 The staff duty record for November 2007 was reviewed to find out how many staff is on duty each day to support residents with their needs. There is at least two staff on duty during the day to provide residents with support in their daily activities. There is one member of staff on duty at night working a `sleeping in’ shift and is available for support if needed. The day-to-day manager who is Mrs Hall-Scott’s sister, lives on the premises, and does the sleeping in shift most nights. She is available for additional support at any time. Based on the evidence from the inspection, the number of staff on duty is meeting residents’ needs. Mr and Mrs Iain Hall-Scott supervise the staff team. There was written evidence in the staff training records that showed that the staff have regalu support and supervion .In discussion with the staff on duty it was evident that the staff feel supported in their work. This benefits residents if staff are supported to be able to provide the care, and have a good understanding of residents and their needs. The staff have done some training run as well as by North Somerset Council, and other training organisations. The staff have done a variety of relevant courses related to residents mental health needs. There was information seen in staff training files that demonstrated staff are also booked to attend forthcoming training in food hygiene, first aid and fire safety. The staff were communicating and supporting residents in a warm manner. All of the residents asked spoke positively of how, `kind’, and ` very helpful’ the staff are. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,41,42. Quality in this outcome area is good. Residents’ benefit from a stable and well-run Home. The health and safety of residents and staff is satisfactorily protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mr and Mrs Hall-Scott have owned and managed the Home for twenty years. Mr Hall- Scott is a Registered Mental Health Nurse, with a number of years of experience working with people with mental health needs. Mrs Hall- Scott is a Registered General Nurse. They are both registered with us as the managers of the Home. This demonstrates Mr and Mrs Hall-Scott are considered suitable and qualified to fulfil the role of registered manager. All of the residents that the Inspector met spoke positively about both of them. They said they were, ‘very nice’, and ‘ they always listen to you ’. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 24 Residents ’ records are kept in a locked cabinet in the kitchen. The care records and records that were seen relating to the running of the Home were satisfactorily written, up to date, and satisfactorily maintained. This helps to demonstrate confidentiality is being protected, and also shows Mr and Mrs Hall-Scott ensure that the legal records required for the running of the Home are in order. Staff are provided with regular training in health and safety matters including first aid, and moving and handling practices. This should help protect residents’ health and safety if staff are trained in health and safety. All staff do food hygiene training to make sure they prepare and cook food safely. Staff check the temperatures of all high-risk cooked food before it is served to people to make sure it is hot enough and safe to eat. The fire logbook record was checked and showed the required weekly and monthly tests of the fire alarms and the fire fighting equipment were being carried out and were up to date. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 X X 3 3 X Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13.2 Requirement The registered persons must ensure there is a metal cupboard for the storage of controlled drugs. Timescale for action 12/11/07 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 YA24 Good Practice Recommendations Action should be taken to remove the stain on the bedroom ceiling identified at the inspection. Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Westgate DS0000008101.V350276.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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