Inspection on 15/08/06 for 1 Charmandean Road

This inspection was carried out on 15th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

1 Charmandean Road 18/09/08

1 Charmandean Road 28/08/07

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 1 Charmandean Road Worthing West Sussex BN14 9LB Lead Inspector Mrs M McCourt Key Unannounced Inspection 15th August 2006 09:30 am 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 Charmandean Road Address Worthing West Sussex BN14 9LB 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) 020 8544 8900 www.caremanagementgroup.com Care Management Group Limited Post Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection New Registration Brief Description of the Service: 1 Charmandean Road is a care home that is registered to provide care for eight adults with learning disabilities between the ages of 18 and 65. The Registered Provider is Care Management Group Ltd and the Registered Manager’s post is currently vacant. The current scale of monthly charges ranges from 1,100 to 1,700. This information was obtained from the Pre-Inspection Questionnaire document. There are additional charges for hairdressing, toiletries, trips out, holidays and clothes. The home is a semi-detached property, situated in a quiet residential street, just outside Worthing’s town centre. There is easy access to all community facilities, including local rail and bus stations. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection was undertaken by one Inspector on Tuesday 15th August 2006 and lasted a total of six and a half hours. Pre-inspection planning took approximately three days. A full tour of the building took place and included the observation of Health and Safety matters, hygiene issues, decorative order and a general overview of the atmosphere created within the home. Four staff members and the Manager were spoken to at the time of inspection. Case tracking was carried out by examination of relevant records and information held on the staff and residents. The Inspector was unable to talk to Service Users due to the nature of their disability, but was able to observe staff interaction. Policies and procedures were examined during the site visit. What the service does well: What has improved since the last inspection? 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 6 The home has recently been taken over by Care Management Group, and therefore it is not easy to see what has improved in such a short space of time, however one member of staff spoken with told the Inspector that the new company has changed the menu for the better, they are also are actively encouraging Service Users to go out more and are assisting Service Users to take regular holidays. She believes that the Service Users are getting a lot more choice regarding their lives. 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. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 5. The outcome for Service Users was found to be adequate. Prospective Service Users individual needs are assessed prior to admission. A Statement of Purpose should be made available to Service Users, visitors and any interested parties all times. The home should ensure a signed contract between the home and the Service User is in place, detailing breach of contract. EVIDENCE: Statement of Purpose and Service Users Guide were not available because a new CMG format has been sent to Head Office to be verified. The documents have not yet been returned to Charmandean Road. The manager said that she will forward copies once they have arrived. The home does have an Admissions and Referral procedure in place. These were forwarded with the Pre-Inspection Questionnaire. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 9 The Inspector sampled two Service Users’ files and found a statement of need and care plan in place for one of the Service Users from the placing authority. The Inspector could not find an assessment for the other file sampled, but one must have been carried out at some point because there was a care plan review on the file, and this was carried out by the placing authority in September 2004. A comprehensive plan of care was seen for those files looked at and contained details of activities, food/drinks likes and dislikes, personal care, healthcare, communication needs and so on. Unfortunately, although very thorough, they have not been signed by the Service Users or a representative. The Inspector could not find a contract for any of the Service Users. The manager said that she is planning to draw up new contracts with each Service User following the change in ownership of the home. The Inspector was of the opinion that this exercise should have been completed at the point of takeover, which was five months ago now. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. The outcome for Service Users was found to be good. Service Users would benefit from more frequent care reviews in order to continuously assess changing needs and requirements. The home supports Service Users to take responsible risks within the scope of their disabilities. Observation of staff interaction found that staff do respect the rights of Service Users. EVIDENCE: Although it is difficult for the home to include Service Users in drawing up their care plans because of their level of understanding, families, relatives and advocacy services could be used to help with the process. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 11 Service Users living at the home have a wide range of health issues, and therefore the home is required to involve specialist care for them. These include; Speech Language Therapy, Wheel chair maintenance, Physiotherapy, and so on. According to records looked at, care plans have not been reviewed by the home. Reviews have been held by social services on a yearly basis. The Inspector was of the opinion that given the various health issues, that these be reviewed more regularly, at least every six months. The home does have details of local advocacy services. Impact Advocacy group has been supporting one of the Service Users with a particular issue. Risk management strategies are documented on individual files, are thorough and well written, but have not been reviewed for many months. General risk assessments are in place for COSHH, medication, fire evacuation, trips out, etc., and these also need to be reviewed. The home does have a written policy and procedure for unexplained absences in place. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 and 17. The outcome for Service Users was found to be good. Service Users are supported to access a range of activities despite their level of disability and are encouraged to regularly visit local community facilities and events. Service Users are supported with a healthy diet EVIDENCE: One of the Service Users has been identified to move into the one of the company’s smaller homes nearby. This should provide him with a more independent lifestyle and will hopefully be better suited to his needs. Service Users attend college courses and partake in art, craft and pottery. One of the Service Users attends SCOPE a couple of days per week. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 13 Service Users take regular trips out into the community; shops, supermarket, restaurants, cinema, and so on. On the day of inspection several Service Users and the manager were on a boat trip. In-house activities include music therapy, drama and reflexology. Families do visit regularly and are able to be seen in private. Menus were seen on display in the home. These showed meals to be healthy, balanced and nutritious. The Inspector ate a meal during the visit, chicken casserole with boiled potatoes and vegetables. It was appetising and tasty. A record of meals eaten is kept by the home, along with the weekly menus. One member of staff spoken with told the Inspector that the new company has changed the menu for the better, they are also are actively encouraging Service Users to go out more and are assisting Service Users to take regular holidays. She believes that the Service Users are getting a lot more choice regarding their lives. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. The outcome for Service Users was found to be adequate. Reviews should be held more often due to the complex needs of the Service Users. Medication procedures are in need of review and improvement. EVIDENCE: The Inspector was not able to fully assess standard 18 at this inspection. Records of health appointments are in place, and include dental, physiotherapy, wheel chair assessments and so on. A diary system and a communication book are used for booking and planning future health appointments, although on the day of inspection staff had forgotten that the reflexologist was visiting to treat Service Users who were on the boat trip! 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 15 Assessments are in place for specific health issues, although it is not clear from records how these are monitored and reviewed. The Care Manager holds a care plan review meeting annually. The Inspector was of the opinion that the reviews should be held more often due to the complex needs of the Service Users. Medication is stored in a lockable, metal, cabinet that is fixed to the wall, which is located in a small locked room. The home uses the Lloyds Pharmacy MDS system and holds a contract with them. Examination of MAR sheets found that there were no discrepancies in signing for medication and all MDS packs were in order. However, a running total of quantities is not carried forward onto the MAR sheet. As the home stocks a large quantity of paracetamol, it is important to stock control and bottles of liquid medication need to be dated upon opening. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The outcome for Service Users was found to be good. Service Users are protected from abuse, neglect and unnecessary self-harm. EVIDENCE: The Commission has not received any complaints in respect of this service. The home does not have a ‘general’ complaints policy, only specific ones. For example, there is a procedure to follow should a Service User wish to complain, and therefore it is not clear how other parties would complain if they needed to. A complaints log book is available but there have been no complaints since the new company took over. The Service Users’ complaints procedure is in picture format and was seen displayed within the home. Records examined during the inspection demonstrated that all staff had received training in recognising signs of abuse and further discussions confirmed that they were fully aware of how to report any concerns. One staff member spoken with demonstrated that she was aware of the various types of abuse, and said that would report any incidents to the manager, or if it was a senior member of staff, social services. The West Sussex County Council Adult Protection procedures were available at the home. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 17 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30. The outcome for Service Users was found to be good. Service Users live in a homely, comfortable and safe environment. EVIDENCE: The Inspector conducted a tour of the building. Accommodation is provided over two floors and includes eight Service User bedrooms, kitchen, dinning room, office, laundry room, lounge/TV room, three shower/bathrooms and five toilets. On the day of inspection the home was clean, tidy and well maintained throughout. Furniture, fixtures and fittings were all of a good standard. The home has access to a maintenance person who carries out small repairs. Service Users’ bedrooms have been personalised to suit individual taste. The Inspector was shown around one of them and briefly discussed with the Service User their collection of pictures on the wall. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 19 The home has a laundry room. A red bag system is used for soiled clothing. Although there are no signs or infection control notices displayed, the manager said that staff are inducted before they do laundry, so she would expect them to be aware of correct practices. There are hand washing facilities available. COSHH cupboards are located inside the laundry rooms, and although there is a sign on the cupboard doors reminding staff to keep them locked at all times, neither of the two cupboards were in fact locked. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. The outcome for Service Users was found to be good. Service Users are supported and protected by the home’s recruitment policy and practices. Service Users are supported by a competent and qualified staff team. Staff should receive regular supervision throughout the year. EVIDENCE: The staffing rota shows that the home employs four staff on an early shift, four staff on a late shift with two waking night staff. In addition there is a driver and a part-time activities person who both work throughout the week-days, helping out where necessary. Staff are trained in Makaton to assist with communication with Service Users. The Inspector looked at two staff files. Seven staff hold and NVQ level 2 or above. Of the files sampled, recruitment procedures show that the home has 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 21 obtained CRB checks and two written references. Also in place on the files are; applications, disciplinary information and induction checklists. The Inspector spoke with three staff members who were able to demonstrate their awareness of Adult Protection issues and confirmed that they do receive supervision regularly, usually every eight weeks, although there were no supervision contracts available. Individual training records are available and the manager said that she liaises with the training department who provide lists of available training courses. In addition specific training requests can be asked for and these are usually provided. There is also a team matrix showing who has received what and when refresher courses are due for individuals. Supervision has not been carried out regularly, in fact, they have not been done since the new company has owned the home. However, the manager said that all staff supervisions are scheduled to take place over the next two weeks. The home does carry out annual appraisals, but these are currently behind also. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. The outcome for Service Users was found to be good. Service Users and staff benefit from a well managed home. The home does have a quality assurance tool to ensure the views of people involved in the home are sought. Health, safety and welfare practices are good and provide protection for Service Users and staff. EVIDENCE: The Registered Manager’s post is vacant. Clare Evans has been in day to day charge of the home for several months now, and has applied to become the Registered Manager. She is currently studying for NVQ 4 and intends to complete the RMA after the NVQ. Ms Evans has managed with the company since June 2004, before that she was an acting manager. Altogether she had 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 23 approximately ten years experience of working with people with learning difficulties. She has attended all mandatory training and is due to do time management, stress management, management skills and Adult Protection part II in the forthcoming year. Observations from staff interaction with the manager found there to be an open and positive atmosphere. Feedback from staff was good. One member of staff said that she is a very good manager; young, but good! The home does have a quality assurance system, called a continuous improvement plan, and the policy and procedure for this was seen by the Inspector and thought to be very comprehensive and thorough. The home uses satisfaction questionnaires, and these are sent out to Service Users, staff and relatives. The Service Users questionnaires are written in symbol format. Mandatory training is provided for all staff and Health & Safety policies and procedures are in place. Monthly Health & Safety checks include; lights, surfaces, fridge/freezer temperatures, 1st aid, decoration and so on. These checks were seen to have been carried out for May and June this year. On examination of the fridge, the Inspector found coleslaw, tomato ketchup, mint sauce, Caesar dressing and Del Monte Juice that were either out of date or had no label on. Storage was poor, with uncooked bacon sitting on top of cooked meats at the top of the fridge. There was also raw chicken in the middle of the shelf, surrounded by salad stuff. Tomatoes were sitting directly on top of the raw chicken! The Inspector concluded that the fridge is too small to cater for an eight bed-roomed house. In addition, temperature checks showed that the fridge is often running high, but there is no action plan for what to do when this happens. A fire file is in place. The home has a service contract with Elite Fire Ltd, and they last carried out a service on equipment on 3rd May 2006. Two drills have been carried out this year, and the Inspector was of the opinion that this is not frequent enough. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 24 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 x 2 3 3 x 4 x 5 2 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 x 26 x 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 3 x x 2 x 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action 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 YA5 Good Practice Recommendations The Registered Manager develops and agrees with each prospective Service User a written and costed contract/statement of terms and conditions between the home and the Service User. 5.2 (v) – The contract specifies rights and responsibilities of both parties, and who is liable if there is a breach of contract. 6.6 – The Plan is drawn up with the involvement of the Service User together with family, friends and/or advocate as appropriate, and relevant agencies/specialists. 6.10 – The Plan is reviewed with the Service User (involving significant professionals, and family, friends and advocates as agreed with the Service User) at the request of the Service User or at least every six months and updated to reflect changing needs and agreed changes are recorded and actioned. 9.3 – Risk management strategies are agreed, recorded in the individual Plan and reviewed. DS0000066940.V300164.R01.S.doc Version 5.2 Page 26 2 YA6 3 YA9 1 Charmandean Road 4 YA20 5 6 YA36 YA42 20.6 – Medicines in the custody of the home are handled according to the requirements of the Medicines Act 1968, the Royal Pharmaceutical Society of Great Britain, the Misuse of Drugs Act 1971 and the UKCC standards for the administration of medicines. 36.4 – Staff have regular, recorded supervision meetings at least six times a year with their senior/manager in addition to regular contact on day to day practice. 42.2 – The Registered Manager ensures safe working practices including; (ii) fire safety and (iv) food hygiene – correct storage and preparation of food to avoid food poisoning. 1 Charmandean Road DS0000066940.V300164.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 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 1 Charmandean Road DS0000066940.V300164.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!