Inspection on 11/03/08 for Sandstones

This is the latest available inspection report for this service, carried out on 11th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sandstones 30/11/05

Sandstones 25/08/05

Sandstones 26/01/05

Sandstones 07/10/04

Sandstones 08/02/04

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 Sandstones 9 Penkett Road Wallasey Wirral CH45 7QF Lead Inspector Inger Moynihan Key Unannounced Inspection 11th March 2008 09:00 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 Sandstones DS0000018936.V352265.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. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sandstones Address 9 Penkett Road Wallasey Wirral CH45 7QF 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) 0151 691 1449 julie.harwood@anchor.org.uk sharon.blackwell@anchor.org Anchor Trust Ms Julie Harwood Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd May 2006 Brief Description of the Service: Sandstones is a purpose built property owned by The Anchor Trust. It was registered to accommodate and provide residential care for 35 older people. The home is close to Liscard town centre and New Brighton. A bus terminal in Liscard gives easy access to other parts of the Wirral and Liverpool. Accommodation is provided in single occupancy flat-lets, this being bed-sitting rooms with a fridge and snack making facility. All of the rooms have an ensuite facility comprising of a hand wash basin and toilet. On the ground floor there is an open plan lounge/dining area. There are two toilets on the ground floor provided for people with mobility needs. There are four bathrooms some with showers in the home. The home is furnished and decorated to a high standard throughout. There is a garden at the front of the home but not at the back. There are no parking restrictions within the immediate vicinity of the home. Security lighting has been installed around the building. Sandstones DS0000018936.V352265.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. Information about the home was obtained through an Annual Quality Assurance Assessment (AQAA) and discussion with the deputy manager and members of the staff team. Policies, procedures and supporting documentation were looked at along with a selection of residents’ case files. A part of the inspection process includes sending questionnaires to residents, staff and health care professionals to obtain their views on the standard of the service. Comments made in these questionnaires are included in the report and contribute to the basis of any judgments made. Fees - £420.00 - £458.45 What the service does well: When a resident moves into the home a plan of their care needs is drawn up so that staff know how to look after them properly. Documentation is in place to indicate residents health care is monitored daily and residents have access to a range of relevant health care professionals such as a GP, district nurse and chiropodist. One resident commented the staff are marvellous, nothing is ever any trouble. Another said on the whole the staff are very good although some are more experienced than others. They are always very polite and very good with my personal care. Four of the five resident questionnaires returned to us indicated they always receive the care and support they need, one questionnaire indicated this was usually the case. The homes routines are flexible which means residents can exercise choice in relation to their leisure and social activities and daily routines. A range of social activities are provided to ensure residents do not become bored and to provide them with social interaction. One resident said I love the activities, it gives me a chance to chat with the other people who live in the home. Another resident said I dont like to join in with the activities, Im happy with my own company and the staff respect this. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 6 Residents said they enjoy their meals and always have plenty to eat and drink, they confirmed they are always offered a choice at meal times. Regular drinks are provided throughout the day. One resident said the food is excellent, I am always offered a choice. Another said the food is very good quality, I always have plenty to eat. The home’s complaint procedure is displayed along with other information on the different agencies residents can contact if they are unhappy about any aspect of the care provided. The standard of the decor at Sandstones remains very high and provides a comfortable and pleasant environment for residents to live. Staff are suitably qualified and competent in their role. What has improved since the last inspection? What they could do better: Some improvements need to be made to the way risk assessments are completed to ensure staff have all the information they need on how to keep the residents safe from harm. Improvements need to be made to the way residents medication is managed to ensure their safety and welfare. Improvement need to be made to the staffing levels to ensure residents care needs are fully met. One of the residents spoken to during the visit stated the staff seem rushed and dont have enough time for you. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 7 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. Sandstones DS0000018936.V352265.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 Sandstones DS0000018936.V352265.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care needs are assessed to ensure the staff can provide the correct level of care. EVIDENCE: Before a resident moves into the home, an assessment of their care needs and any risk factors affecting their wellbeing is carried out. This gives staff all the information they need on how to look after the person properly and keep them safe from harm. Some improvements need to be made to the way risk assessments are completed to ensure staff are clear on how to ensure residents are kept safe from harm. Intermediate care is not provided at Sandstones. Sandstones DS0000018936.V352265.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health and personal care needs are met, however, some improvements need to be made to the way residents medication is managed. EVIDENCE: When a resident moves into the home a documented plan of care is drawn up. The care plan covers a range of issues relating to residents care needs and gives staff guidance on how to look after the person in accordance with these needs. Documentation is in place to demonstrate that residents physical and mental welfare is monitored regularly and they have access to a range of relevant health care professionals, i.e. a GP, district nurse and chiropodist, to support them with their physical and mental welfare. While the care plans have recently been updated, the deputy manager agreed they need to be streamlined in order to demonstrate more easily how the care is being provided. In some instances it was not easy to establish the meaning of some documents and how they fitted into the care plan. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 11 The residents spoken to during the visit confirmed the staff respond promptly to their health care needs and they see their GP when necessary. One resident commented the staff are marvellous, nothing is ever any trouble. Another said on the whole the staff are very good although some are more experienced than others. They are always very polite and very good with my personal care. Two of the resident questionnaires returned to us indicated they usually receive the medical support they need, the other two questionnaires indicated they always receive the care they need. One questionnaire noted the staff are very caring. Four of the five questionnaires indicated they always receive the care and support they need, one questionnaire indicated this was usually the case. Systems are in place for the safekeeping and handling of residents’ medication and only trained staff are allowed to administer medication. Staff have access to the policy and procedure in relation to this aspect of care provision. Safe facilities are in place for the storage of residents medication and all of the residents spoken to said they receive their medication as prescribed by their GP. During the visit it was reported that an error had been made in the way controlled drugs were being managed; this was rectified during the visit. To ensure residents safety and welfare, residents medication must be managed correctly at all time. Arrangements have been made for the CSCI pharmacist will visit the home in order to carry out a more in depth audit and to give advice and support. It was reported that sometimes, residents medication is changed by a GP over the phone. Although a procedure is in place for this, some difficulties are being experienced in getting all parties to follow this procedure. The registered person must look into this issue to ensure proper documentation is obtained before medication is changed in this way. Sandstones DS0000018936.V352265.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 excellent. This judgement has been made using available evidence including a visit to this service. The homes routines are flexible which means residents can exercise choice and control in their lives. A varied and nutritious diet is provided to ensure residents interest and good health. EVIDENCE: The homes routines are flexible which means residents can exercise choice in relation to their leisure and social activities and daily routines. A part time activity organiser is employed at the home. She provides a range of social activities during the week to ensure residents do not become bored and to provide them with social interaction. The residents spoken to confirmed they enjoy the activities and acknowledged the staff respect their decision not to join in. One resident said I love the activities, it gives me a chance to chat with the other people who live in the home. Another resident said I dont like to join in with the activities, Im happy with my own company and the staff respect this. All of the residents spoken to during the visit confirmed they are happy with the homes routines. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 13 Residents confirmed their family and friends can visit at any time, which means they can maintain personal relationships. A minister visits the home every Sunday and communion is given every month. An ecumenical service is arranged regularly. Some residents go out with the family but no service users go out of the home on their own. Residents said they enjoy their meals and always have plenty to eat and drink, they confirmed they are always offered a choice at meal times. Regular drinks are provided throughout the day. One resident said the food is excellent, I am always offered a choice. Another said the food is very good quality, I always have plenty to eat. This was further supported in the residents questionnaires returned to us. One Resident commented she would like to change the way her meals are provided for medical reasons. The deputy manager will address this issue. Mealtimes are relaxed and informal and staff are on hand to help when necessary. Staff are aware of residents dietary care needs and ensure their individual preferences are catered for. Staff are currently attending a training course on Dignity in Dining to further improve this area of care provision. Sandstones DS0000018936.V352265.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. Residents know their complaints will be listened to, taken seriously and acted upon. Systems are in place to ensure residents are protected from abuse. EVIDENCE: The home’s complaint procedure is displayed along with other information on the different agencies residents can contact if they are unhappy about any aspect of the care provided. We have not received any complaints about this service. The home has received one complaint, which has been investigated and concluded. The residents spoken to said they know who to contact if they wish to make a complaint and staff are aware of the action they should take in the event of them receiving a complaint. Three of the five residents questionnaires indicated they did not know how to make a complaint. The registered person must ensure all residents know who to contact if they want to make complaint. All staff have completed training on the protection of vulnerable adults from abuse. Through discussion they demonstrated a basic understanding of the different types of abuse that can occur and were clear on the action they should take in the event of them suspecting or knowing an incident of abuse has happened. A policy and procedure relating to the investigation of any Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 15 allegations of abuse was in place along with a copy of the Wirral adult protection procedures. All of this ensures allegations of abuse are investigated and dealt with properly. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the decor at Sandstones remains very high and provides a comfortable and pleasant environment for residents to live. EVIDENCE: The standard of furnishings throughout the home remains very high and the grounds are well kept. A programme of routine maintenance is in place to ensure the home is well maintained and provides a comfortable and pleasant environment to live in. Plans are being made to build a conservatory at the back of the building in order to provide more lounge space. The standard of hygiene remains very high and there are sufficient laundry facilities to cater for the number of people living at the home. The laundry door must be kept locked at all times to ensure residents cannot wander into this room as it is a high risk area. Systems are in place to control the spread Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 17 of infection along with supporting policies and procedures, which staff can refer to when necessary. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff are suitably qualified and competent in their role. Improvement need to be made to the staffing levels to ensure residents care needs are fully met. EVIDENCE: Discussion with staff indicated there are insufficient care staff working at the home during the afternoon and evening for the number of people living there. While it is acknowledged that staff are currently being recruited, the staffing levels must not be left to fall to an unacceptable level, given the high dependency levels of some residents. One of the residents spoken to during the visit stated the staff seem rushed and dont have enough time for you. Three residents questionnaires indicated the staff are always available when needed, two questionnaires indicated this was usually the case. Three of the five staff questionnaires returned indicated there are usually enough staff to meet the individual needs of the residents. One questionnaire raised a concern about staffing levels. Two questionnaires indicated there are always enough staff on duty. There is a rolling programme of training to the National Vocational Qualification (NVQ) standards. Documentation indicated that 71 of the permanent care staff are trained to NVQ level 2 or above. More staff are also working towards this award. The home therefore meets the National Minimum Standards Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 19 recommendation of 50 of staff being trained to NVQ level 2 or above by 2008. Thorough recruitment procedures are carried out to ensure suitably qualified and competent staff are employed to work at the home. Documentation examined indicated that appropriate checks had been carried out on all staff. Staff are provided with induction training when first employed to ensure they know how to care for the residents in accordance with the particular needs and are aware of the homes routines and management structure. Staff confirmed they have completed a range of training relevant to their role. This was also stated in the staff questionnaire returned to us. The training programme should be developed to include more specialist training such as the conditions of old age and alcoholism etc. Training in relation to equality and diversity has not yet been provided. Without this training staff may not have a full understanding of the complex nature of issues relating to residents age, disability, gender, faith or religion, race and sexual orientation. Staff are encouraged to attend relevant training, which they confirmed was useful for their job. This is a positive aspect of the home and ensures staff are kept up to date with changing care practices. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 20 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, 33 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is well managed and run for residents best interests. EVIDENCE: There are clear lines of management and accountability within the home, which is run for residents best interest. Mrs Julie Harwood is qualified to NVQ level 4, which is the recognised qualification for a manager of a residential care service. The registered manager is currently on sick leave and her post is being covered by the deputy manager. One health care professional questionnaire was returned to us. This made positive comments about the home and the manager. She said the management structure is good and staff follow her instructions when necessary. She stated there is good communication amongst the staff team who are professional and caring. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 21 Quality assurance systems are in place to ensure the efficient and ongoing improvement of the home. Staff meet regularly with their manager and regular training is provided. Communication amongst the staff team is good and there are clear lines of accountability within the organisation. Systems are in place to ensure residents views are sought and acted upon. These systems include direct contact with residents, questionnaires and residents meetings. Staff meet regularly with their line manager to discuss their development in their role. They said they found this meeting useful as it gave them an opportunity to discuss any issues or concerns around their work. All of the staff said they enjoyed their work and felt well supported in their role. They spoke highly of the manager and senior staff saying they are always available for advice and support. This was further supported in the staff questionnaires returned to us. Safe working practices are promoted throughout the home. Staff are provided with ongoing training in this aspect of care and are given sufficient materials to carry out their work safely. Regular fire safety checks are carried out on all equipment and most staff have completed fire safety training. The remaining staff will complete this training by the end of April 2008. Staff said they can access policies and procedures relating to this aspect of care provision to support them in their role. The home is subject to its own internal health and safety inspection and all accidents are recorded and monitored. Although regular health and safety checks are carried out, the supporting records had not been completed to reflect this. This was also identified in the companys own health and safety audit. Also the accident records had not been uplifted onto the computer to enable them to be monitored and the risk assessment for the building had not been updated since 2006. The member of staff responsible for the buildings health and safety acknowledged he needed to update his training in this area. To ensure residents and staff safety, the registered person must ensure all records are kept up to date. Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 x 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 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 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 2 Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 13 Requirement More detailed information must be collated when carrying out a risk assessment to ensure staff have all the information they need on how to keep the residents safe from the risk of harm Information held in the care plans must be recorded in a way that staff understand, so that all aspects of residents are needs are met. Residents medication must be managed correctly to ensure their safety and welfare. Appropriate staffing levels must be maintained at all times, which reflect residents care needs. The registered person is required to ensure all staff are provided with training on issues of equality and diversity. (Previous requirement timescales of 31/3/05 and 31/7/06 have not been met). More specialist training must be provided to ensure staff are up to date on residents particular care needs. In this instance the DS0000018936.V352265.R01.S.doc Timescale for action 11/05/08 2 OP7 15 11/05/08 3 4 5 OP9 OP27 OP30 13 18 18 11/03/08 11/03/08 11/08/08 6 OP30 18 11/08/08 Sandstones Version 5.2 Page 24 6 OP38 13 registered person should write to the CSCI and inform them of when this training will be provided. A record must be kept of any 11/03/08 health and safety checks that are carried out to ensure this aspect of care provision can be monitored and reviewed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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 Sandstones DS0000018936.V352265.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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