Inspection on 22/04/08 for Maudes Meadow

This is the latest available inspection report for this service, carried out on 22nd April 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Maudes Meadow 24/11/05

Maudes Meadow 25/05/05

Maudes Meadow 19/01/05

Maudes Meadow 10/11/04

Maudes Meadow 29/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Maudes Meadow Windermere Road Kendal Cumbria LA9 4QJ Lead Inspector Jenny Donnelly Key Unannounced Inspection 22nd April 2008 09:15 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 Maudes Meadow DS0000035531.V360949.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. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maudes Meadow Address Windermere Road Kendal Cumbria LA9 4QJ 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) 01539 773092 01539 773087 www.cumbriacare.org.uk Cumbria Care vacant Care Home 28 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (28) of places Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. The home is registered for a maximum of 28 service users to include: - up to 28 service users in the category of OP (Old age not falling within any other category) - up to 10 in the category of DE(E) (Dementia over 65 years of age). The staffing levels in the home must meet the Residential Forum Care Staffing formula. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. 5th May 2006 3. 4. Date of last inspection Brief Description of the Service: Maudes Meadow is a residential care home registered with the Commission for Social Care Inspection to provide accommodation for up to 28 older people, 10 of whom may have dementia. The home is owned by Cumbria County Council and carried on by Cumbria Care, a County Council business unit. Maudes Meadow is in a quiet residential area, a short walk away from Kendal town centre and local amenities. The property is a purpose built two-storey building with a passenger lift to help people access the first floor. There are twenty-eight single bedrooms. The accommodation is arranged into two living units, one for people with dementia and one for frail older people. Fees range from £337.00 to £449.00 per week, depending on the level of care required. Information about the services provided and fees charged is included in the homes statement of purpose and service users guide. Copies of recent inspection reports are displayed in the home. Maudes Meadow DS0000035531.V360949.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 was the main or ‘key’ inspection of the service. Jenny Donnelly inspector, made an unannounced visit to the service on 22nd April 2008. During the visit we (the commission) toured the building, spoke with residents, staff and the management. We looked at care, medication, staffing and management records. We saw how people were spending their day, and observed lunch and the day’s activities. Prior to this inspection the manager had completed and returned an Annual Quality Assessment Audit (AQAA) that we had requested. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also sent surveys out to some of the people who live in the home, their relatives and to staff. The findings of the surveys are included in this report. What the service does well: What has improved since the last inspection? Since the last inspection a number of improvements have been made in this service. A new easy read information booklet has been produced for new residents and their families, which answers some of the commonly asked Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 6 questions. People’s nutritional assessments have been updated using a more detailed assessment tool. The management of medicines has been reviewed and the medicine records have been updated. Secure storage for medicines has been provided in people’s bedrooms should they wish to manage their own medicines. A new carpet has been provided in the upstairs corridor, some areas of the home have been redecorated and a number of new commodes have been purchased. 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. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 7 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 Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 8 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, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides good information for people, and spends time and effort in making sure people are suited to this care home and are assisted to settle in well. EVIDENCE: The care home has produced detailed written information for people who are enquiring about the service. This includes a statement of purpose, a service user guide, the results of recent satisfaction surveys and copies of our inspection reports. These are all on display in the entrance hall. A recent addition is a large print easy read booklet answering commonly asked questions about life in the care home. This was put together using ideas and suggestions from people living in the home and their friends and relatives. People are welcome to come and look around the home, and to stay for short visits. Some people have a short respite stay before deciding to move in on a Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 9 permanent basis. People we spoke to felt they had been made very welcome by staff and had settled into the home quickly. Peoples’ health, personal and social care needs are assessed prior to them being offered a place in the home. This is to ensure the home is a suitable for them and that staff will be able to meet all their care needs. When assessing a new person, staff try to take account of the needs of people currently living in the home to avoid any possible frictions. The service does not provide intermediate care. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were consistently receiving good quality personal and healthcare that suited their needs and preferences. EVIDENCE: There was a written plan of care in place for each person, which guided staff in what level of help people needed, and when. We examined four care plans in detail and found they were fully completed and had been kept up to date. The plans included information about people’s individual wishes on the way they liked to receive care and clearly set out any special requirements. The ‘personal profiles’ provided some valuable information, especially for those people suffering from dementia, about what was important to them and what they had achieved in their lives. This helps staff to understand people’s behaviours better and provides good information for planning appropriate social care. New nutritional assessment sheets were being completed which showed any special nutritional needs in more detail. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 11 Health care records showed that people had good access to their doctor and were able to regularly access other health services such as chiropody, optician, physiotherapy and dental care. There was evidence that staff had taken on board advice from these professionals and incorporated any necessary information into the persons care plan. It was clear from records that care staff were proactive in noticing health care needs and prompt in reporting these to the supervisor for action. People who needed it, had specialist equipment in place, such as profiling beds with pressure reducing mattresses. The community nurse visited a number of people to monitor their long-term health conditions, and there was good liaison with mental health services for people with dementia needs. People told us they were happy with the health and personal care provided and felt staff treated them with dignity and respect. Here are some of the comments we received; • “I am very content here, I get everything I need, I’m very lucky” • “I love my weekly bath, the staff help me in, and let me have a good soak” • “I am much happier now about the care my mother receives. The care staff are almost always excellent, there is a greater appreciation of my mothers problems, and as a result she is as happy and content as is possible to be under the circumstances” • “We have great peace of mind that mother is being well looked after”. One person told us they would ‘like a bath more often but this was not allowed’, and one relative said, ‘They did not mention that (my relative) had a minor fall’. We inspected the management of medicines and found that everything was in order. The manager had asked peoples doctors to review all medication prescribed and she was in the process of updating records accordingly. The ‘homely remedy’ and ‘as required’ medicine lists had also been updated. Homely remedies are agreements signed by the person’s doctor for staff to give simple remedies such as mild pain relief without the need to consult the doctor. The ‘as required’ medicine information sheets tell staff what the medicine is for and describe when to give it. These are particularly useful in helping staff to know when to give sedating medicines safely. It is good practice that medicine records are reviewed and updated periodically. There were systems in place for people to manage their own medicines within in a risk assessments framework, and people had secure storage in their bedrooms for this purpose. No one was currently choosing to manage his or her own medicines. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were enabled to make choices over their day-to-day lives and said they were content living in Maudes Meadow. EVIDENCE: People were able to choose how to spend their day, with some people making full use of the communal rooms, whilst others chose to stay in their bedrooms and just come out for meals. There were occasional entertainments provided, and people told us about visiting singers and musicians. There were monthly outings for 5 to 6 people plus support staff, and the manager ensured different people were offered the opportunity to go each month. The provision of dayto-day activities was more ‘ad hoc’ and there was no weekly programme in place. The manager said she was trying to raise the profile of activities and occupation and encourage the care staff to take more responsibility for organising these. A lack of regular organised activities was raised in the homes recent satisfaction surveys and we were also told; • “Perhaps a few activities such as bingo, word games, quizzes to keep brains active would be good”. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 13 We did observe that staff were able to spend time chatting with people, especially over lunch time and early afternoon. Some people were quite independent and occupied themselves with their own interests, and were left by staff to do so. People told us they were happy with the meals offered, saying there were always two choices and the quality of the food was good. We observed the lunchtime meal and saw that people got the choices they asked for. The mealtime was pleasant and relaxed and people were able to enjoy sitting and chatting around the table if they wanted. Special diets were catered for and staff knew who had special dietary needs. People were provided with adapted cutlery, as they needed to help them maintain their independence. Menus had recently been revised through consultation with the people living in the home. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home felt safe, knew how to raise concerns and felt they would be listened to. EVIDENCE: The home had a clear complaints procedure that is handed out to new people and their families. A copy was also on display in the entrance. The manager reports having not received any complaints in the last year, and none had been made to us. People told us they knew how to complain but had not needed to do so. People said they could raise minor concerns or queries with the supervisors or manager and felt confident they would get a response. • “The response now is very good” • “The home makes my mum feel safe and secure” There was information in the home on local advocacy services and one person we spoke with did have an independent advocate to act on their behalf if needed. Staff had received training on safeguarding people as part of their induction and National Vocational Qualification. There were also specific in-house training days on safeguarding and protection, which a number of staff were booked to attend. Through discussion with staff it was evident that people understood the principles of safeguarding and were aware of local reporting procedures. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 15 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, 20, 21, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a clean and comfortable home, but some of the bedrooms are small and some work is now needed to maintain a good standard of décor in all areas. EVIDENCE: Maudes Meadow is a purpose built care home set on the edge of the town of Kendal. The home is divided into two units; the secure dementia care unit is all on the ground floor, and comprises of a dining lounge, bedrooms, and a communal bathroom. The general elderly frail unit has bedrooms and two bathrooms on the first floor, and the dining room and a lounge on the ground floor. There is a small smoking room near the front door. Outside space is limited comprising of a small fenced patio area with seating. There is a passenger lift. Bedrooms varied in size and there was waiting list system for Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 16 people to move to bigger bedrooms as they became available. All bedrooms had a wash hand basin, but only a few had an ensuite toilet. Since the last inspection the upstairs corridor carpet had been replaced, there were some new commodes and armchairs, a few bedrooms and a dining room had been re-decorated. Some areas of the home looked smart but other areas, especially bedrooms in the dementia unit, had become shabby and were in need of redecoration. The three bathrooms were spacious and equipped with specialist baths, and one had a separate shower cubicle. There was a lack of storage facilities in the bathrooms, which meant that towels and continence products were piled up on trolleys, which looked untidy. The manager said she was hoping to get some store cupboards and this would make a big improvement to peoples bathing experience. The home was clean and fresh throughout and the laundry arrangements were satisfactory. Staff used dissolvable laundry bags for infected laundry, and were provided with disposable gloves and aprons. One washing machine had just been replaced with a newer model. There were grab rails and call bells throughout the home. People told us, • “It is a secure environment” • “They need en suites for old people to give them privacy and also need bigger rooms because they are too small” • “My relative would like a larger room with own bathroom, she needs to have things from home around her, I think this is important as most people have had to give up their own home” • “Not only is the home a welcoming place it is also very accessible to all local amenities for example doctors, hospital, shops, parks and easy for friends and relatives to visit which is a very important factor” Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are cared for by a competent and caring group of staff. EVIDENCE: The staff team at Maudes Meadow is well established, although there were vacancies for three care staff. These shifts have mostly been covered by regular use of agency care staff. The manager attempts to have five staff on duty throughout the day, but on occasions can only manage four on evening shifts. They are in the process of placing adverts for care staff and the manager hopes if she can recruit to these vacant posts, there will be more time for staff to spend on activities and additional bathing. Staff we spoke with felt that staffing numbers were satisfactory to meet people’s needs at the moment, describing the home as ‘fairly quiet’ and ‘calm’. However it is noted that activities were minimal and baths were restricted to once a week. Staff told us they felt well supported in the home and felt that they received a good amount of training to keep up to date. New staff complete a five-day induction and 95 of the care staff have a National Vocational Qualification in care, which is excellent. Staff said they had access to in house training events, although places were limited. The manager coordinates bookings and tries to ensure at least two staff go on each event and can share their learning with colleagues. Staff working on the dementia unit confirmed they had received training in dementia care and attended updates periodically. There was also Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 18 evidence of other condition specific training as appropriate to peoples needs. Examination of three staff files showed that all necessary recruitment checks were in place. Staff were seen to interact well with people and were willing to spend time chatting and socialising, which people clearly appreciated. We received the following comments about the staff; • “Care staff have all been extremely pleasant, informative and caring” • “There has been great improvement in the overall attitude and recognition of my mothers disability” • “Staff always are on hand for a chat and make us feel very welcome every time we visit” • “Care staff relate well to residents and recognise their individuality”. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 19 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, 35, 36 and 38 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of people who live there. EVIDENCE: The home manager, Susan Bolderstone, has been in post since August 2007 and is in the process of applying to the commission to be registered as the manager of this service. A company operations manager visits the home regularly to support her in her role. The company operates a quality assurance process that includes monthly checks to ensure the service is operating within their expected standards, there are regular residents meetings where people are able to make their views and wishes know, and there is an annual satisfaction survey. The latest Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 20 survey was undertaken in March 2008 and the results were on display in the home. We looked at these and found they were very positive about all aspects of the service, except for activities and menus (which have since been revised). People can request the home to look after their spending money if they wish, and the arrangements for this are robust. There are separate money wallets held securely in the safe and each person has a record book, which is signed by two staff for each transaction recorded. We checked the balances for three people and found them to be correct. People are able to manage their own finances if they wish. Staff confirmed they received regular supervision meetings with their supervisor or manager, and we saw from the records that care practices and training needs were discussed in these meetings. We looked at the fire log and other safety records, and these were up to date and showed all safety checks were completed regularly. Staff had received updates in fire safety and in safe moving and handling. All kitchen staff had completed food hygiene training and the environmental health officer had awarded the home four stars for food safety in June 2007. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 21 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 X 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 3 X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 22 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 OP31 Regulation 9 Requirement The manager must apply for registration with the Commission for Social Care Inspection. Timescale for action 01/08/08 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 2 3 4 Refer to Standard OP12 OP19 OP21 OP27 Good Practice Recommendations It is recommended that more opportunities for daily activities and occupation is made available for people. It s recommended that a programme of redecoration is implemented to keep all areas of home to a good standard. It is recommended that storage facilities be provided in the bathrooms. It is recommended that staffing levels be maintained sufficiently to meet peoples personal and social care needs. Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Maudes Meadow DS0000035531.V360949.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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