Inspection on 02/10/07 for 10 Exmoor Crescent

This inspection was carried out on 2nd October 2007.

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

10 Exmoor Crescent 24/07/06

10 Exmoor Crescent 12/01/06

Similar services:

Insight - Eastchurch

Southfields

Thorndene

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 08/07/2008.

CARE HOME ADULTS 18-65 10 Exmoor Crescent Durrington Worthing West Sussex BN13 2PL Lead Inspector Ms A Campbell-Currie Key Unannounced Inspection 2nd October 2007 10:00 10 Exmoor Crescent DS0000064725.V347401.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 10 Exmoor Crescent DS0000064725.V347401.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. 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 10 Exmoor Crescent Address Durrington Worthing West Sussex BN13 2PL 01903 693050 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) Outreach 3 Way Mr Michael Paine Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to three (3) service users aged from 18-65 years in the category of Learning Disability may be admitted/accommodated. 24th July 2006 Date of last inspection Brief Description of the Service: 10 Exmoor Crescent is a care home registered to provide accommodation for up to three adults with a learning disability. The property is a detached bungalow with three bedrooms situated in a residential area of Durrington. The garden is at the side of the property with an enclosed paved area to the rear. The establishment is close to some local shops and is approximately five miles from Worthing town centre. Outreach 3 Way owns the service. The responsible individual on behalf of the providers is Mrs Vanessa Keen. The registered manager is Mr Michael Paine. The current weekly fees are £1720. 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit for the key inspection took place over a morning and early afternoon. The registered manager is currently absent and a manager designate has been in post since May. The manager designate, the deputy manager and the member of staff also on duty assisted with the inspection and the required information and documents were made available. Before the inspection the manager designate completed an Annual Quality Assurance Assessment (AQAA) form that provided a great deal of useful information about the service. Surveys were received from the three service users with the help of staff, three relatives and seven staff. The comments made about the care provided by the service were very positive. One service user had left for a holiday with the support of care staff in the morning and the other two people living in the home were preparing to go out for lunch. All the rooms and the gardens were seen and the two staff on duty were spoken with. The people who live in the home have profound communication difficulties so it was difficult to find out directly from them what they think about the service. The staff understand each person’s method of communication and were communication well with service users. The interaction was relaxed and people were content. The outcome for people was measured against the key National Minimum Standards for Younger Adults. Two requirements were made following the previous inspection; these have both been addressed. Judgements were made from evidence gathered during the inspection, which included a site visit to the service and takes into account the views and experiences of people using the service, as well as evidence gathered from a range of sources since the last inspection of the home. What the service does well: The service users benefit from living in a small home with individual support. The environment has been adapted to their needs and retains a very homely atmosphere. Care plans and risk assessments are detailed so that staff understand people’s needs. People are offered a range of activities and have the opportunity of a holiday each year. The comments received from relatives about the care in the home were very positive: “Staff are given training. Everyone is friendly and kind. I cannot find fault with 10 Exmoor Crescent. My daughter is very happy and I am shown compassion at all times”; “we have always been kept informed of my relative’s 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 6 welfare. We have been very pleased with the care they receive. The carers make a special effort to keep in touch with us”; “we are always informed of health issues. We are extremely satisfied”. The staff spoken with and those who returned surveys were positive about the care provided in the home, “care for the service users is at an exceptionally high standard. Effort has been made recently to improve their diet and leisure activities”; “the service makes sure staff are well trained and give the right training for the job”; “the service ensures that all service users are comfortable and content to make sure they feel safe in a homely environment” and “ Exmoor is the best place when it comes to the service users and staff”. What has improved since the last inspection? 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. 10 Exmoor Crescent DS0000064725.V347401.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 10 Exmoor Crescent DS0000064725.V347401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with the information they need to make a decision about moving to the home. There is a thorough pre-assessment process to make sure their needs could be met. EVIDENCE: There is a Statement of Purpose and Service User Guide that is provided in a format that is accessible to people who have communication difficulties. The information has been updated to reflect the recent staff changes in the home. The relatives who returned surveys said that they have enough information about the home. The organisation has a rigorous admission policy. The three people living at 10 Exmoor Crescent all went through a thorough assessment process before a decision was made about them moving to the home. The manager designate said that the people living in the home all knew each other before they moved and that they are very compatible. Staff said that they understand the assessed needs of service users. 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 9 10 Exmoor Crescent DS0000064725.V347401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ assessed and changing needs and personal goals are reflected in their care plan and these are kept under review. People are supported to make decisions about their daily lives and risk assessments are carried out to support their independence. EVIDENCE: Samples of case records were read and showed that people’s needs had been documented in detail with guidance provided to staff about the way care should be provided. The care plans had been drawn up from information gathered before the person moved, relatives, service users themselves and observation of their behaviour. All aspects of the person’s daily needs were documented including social and emotional needs and communication. People’s spiritual wishes have also been gained with the help of relatives. 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 11 Risk assessments had been carried out in all aspects of daily life and detailed guidance provided to minimise risks. There was also guidance to staff about certain aspects of behaviour management. There was evidence to show that care plans had been reviewed and that changes were documented. The manager designate said that she is reviewing the way that changes are recorded to ensure that guidance is clear to staff. The organisation has agreed to more dedicated time for administration; this will give her time to keep all documents up to date. Examples were given of issues that were identified during a service user’s review and additional services sought to meet the person’s need. Detailed daily report sheets are kept and include notes about all aspects of each person’s day. Staff keep each other informed of any key issues and the sheets are monitored by the manager designate. People are supported to make choices within their ability to do so. Various methods are used to facilitate choice including pictures and the item such as whether they wish to have a drink of coffee or fruit juice. The manager is looking into assistive technologies that would help people to communicate their wishes more clearly. One person has recently been supported to be more independent with shopping following a risk assessment. There are advocacy services available and all service users have relatives who are closely involved in their care. The surveys from relatives showed that they are kept informed of any changes and that staff include them in any decision making that is needed when appropriate. All service users have their own bank account and financial records and people are supported to go to the bank or building society when they need to. 10 Exmoor Crescent DS0000064725.V347401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to take part in activities of their choice and access community facilities. People are supported to maintain contact with their friends and family and are offered a healthy diet. EVIDENCE: People are provided with a range of leisure activities and opportunities for personal development. Interests and wishes regarding activities were noted in the assessment and care plans, with details about the things that people enjoy doing. There are a number of activities available in the house including games, puzzles, books and DVDs. People are also supported to attend local day care facilities, college courses and community activities such as swimming and shopping. 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 13 On the day of the site visit one person had left for a few days holiday to the Norfolk Broads and the two other people in the home were preparing to out for lunch to a public house in the country. The vehicle that is used is suitable for wheelchairs and all staff are insured to drive it. The daily recording sheets show that all activities are noted to make sure that people are provided with a choice. Spiritual needs and wishes were also documented and acted on when people choose to attend church. The manager designate said that this information had been gathered from relatives as well as service users. The staff on duty said that they are aware of places that are suitable for wheelchairs and welcome people with disabilities. The organisation has developed a ‘Dignity Challenge’ DVD involving service users who live in other homes in the organisation. The DVD highlights some of the issues for people accessing community facilities; people living in the home have watched it, so that they can understand the organisation is making progress in helping people to access community facilities. Feedback from family members showed that the home encourages people to maintain contact with their relatives. Records showed that people are supported to visit their families and that visitors are made welcome in the home. Comments on the surveys included: “ I am shown compassion at all times” and “the carers make a special effort to keep in touch with us”. People are provided with a varied and balanced diet. Dietary needs were noted in the care plans with guidance to staff about the way food should be presented. The daily record sheets include details of the food people eat each day and their weights are checked and monitored each month. People eat at the table in the dining area of the lounge; one person sometimes chooses to eat in their room. 10 Exmoor Crescent DS0000064725.V347401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive the personal and health care support they need. People are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The case records seen showed that people’s personal and health care needs were clearly documented. The care plans provided detailed information about the way care should be provided. There were records to show that service users had been seen by GPs and health care professionals as required. Regular health checks including medication reviews are arranged by the staff and recorded in the care notes. The manager designate carries out monthly checks to ensure that all planned appointments have taken place. The service users have access to services provided by the local Community Team for People who have Learning Disabilities (CTPLD); this includes speech and language therapy, physiotherapy and occupational therapy. People also 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 15 have access to alternative therapies that improve their well being, including aromatherapy and head massage; these services are at an additional cost. Staff receive induction and guidance about the way to provide personal care. People’s preferences are also detailed in the care plans. The service users have profound needs and communication difficulties so it is difficult to be sure that care is provided in the way that they wish. The manager and staff said people are able to indicate their preferences by signs or movement and they are all able to indicate displeasure. The medication storage, records and administration were seen. All staff have had training in medication issues and are competent to administer medication. There is a pharmacy agreement with a local chemist and staff said that there is a good relationship with this service so that people always receive the medication that they need. 10 Exmoor Crescent DS0000064725.V347401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can feel that their complaints are listened to and acted upon. The policies and systems in place ensure that people would be protected from abuse or self-harm. EVIDENCE: There is a complaints policy that is provided in symbol format to make it easier for service users to understand. The manager designate said that staff understand the signs and signals when people are unhappy and find out what they are unhappy about. Feedback from the surveys indicated that relatives know how to make a complaint and that they are confident that their concerns or complaints would be addressed. There is a system for recording complaints and the manager’s response to them. Three complaints have been received in the past twelve months, none from service users or relatives. All complaints had been dealt with appropriately. Policies are available regarding safeguarding adults and all staff have attended training in adult abuse so that they would recognise the signs and symptoms. The manager designate and the staff who were on duty were clear about the need to follow the safeguarding adults policy and protect the person involved. The case records showed that guidance is provide to staff regarding challenging behaviours and the way this should be avoided or dealt with. There are procedures and recording systems for protecting people’s finances. These 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 17 were seen to be in order. Criminal Record Bureau (CRB) checks are carried out for new staff and they do not begin work until the check has been returned. 10 Exmoor Crescent DS0000064725.V347401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 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 provided with a homely, clean, hygienic and safe environment. EVIDENCE: The home was clean, bright and free from unpleasant odours. The building and grounds are well maintained. The carpets are worn and stained in places; the manager designate said that the budget has been agreed to replace all worn carpets. There is also a plan to replace the lounge and dining room furniture. The care staff are responsible for cleaning duties and service users are involved in tasks they are able to perform. One person is supported to keep his room tidy. A conservatory is to be built at the back of the house; this will provide office space as well as a larger communal area. The manager said that there are plans to make better use of the front garden so that people can have a more 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 19 sensory experience when the weather is good. The manager said that the fire officer has visited the home recently and was satisfied with the risk assessments and fire procedures. There is a domestic laundry that is suitable for the size of the home. The home has a contract with a clinical waste disposal firm. Protective clothing and hand washing facilities are provided. Staff are provided with guidance about infection control as part of their induction. 10 Exmoor Crescent DS0000064725.V347401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent and qualified staff. The recruitment process protects service users and their needs are met by staff who are appropriately trained. EVIDENCE: There were two care staff assisting two service users during the site visit. The manager designate assisted with the inspection. The rotas showed that there are sufficient numbers of staff to meet the needs of the people who live in the home. The manager said that there is now a full compliment of staff and newly recruited staff have completed their induction training. The staff on duty were spoken with and both said that it was difficult covering shifts during the summer but the situation has improved now. In an emergency staff could be provided from another local home in the organisation and these relief staff would understand the needs of the people living at Exmoor Crescent. There is a robust recruitment policy and process that follows the organisations equal opportunities policy. Recruitment records are kept at the head office in 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 21 Crawley. The records that are kept in the home showed that all the necessary checks had been carried out before staff began work. The manager said that she is considering ways that service users could be involved in the interview process; at the moment they only meet new staff after their appointment. Three of the ten care staff have achieved the National Vocational Qualification(NVQ) level two and seven are registered to study for the award. There is a comprehensive induction and training programme. Staff who returned surveys and those spoken to on duty said that they are supported to attend training and that they are provided with the knowledge and skills they need to provide the care. 10 Exmoor Crescent DS0000064725.V347401.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home. Their views underpin the development of the service. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The registered manager is currently absent. The manager designate has been in post since May; she has management experience in services for people who have a learning disability. The manager designate has recently been allocated dedicated time in the home for administration; this has been an issue in the 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 23 past when the person in this role was frequently on the duty rota to cover shifts. There is an annual quality assessment process and the views of service users, relatives and other stakeholders are sought. The questionnaires for service users are in a picture format and they are assisted to complete them. The outcomes are collated and used to plan developments in the home. The manager carries out a monthly audit and review of records in the home and the providers carry out Regulation 26 visits monthly to make sure the home is running well. All staff have attended mandatory health and safety training as part of their induction and also to update their knowledge; these records were seen. The health and safety systems and records in the house were discussed with the manager. All equipment is serviced on a regular basis and the fire officer is satisfied with the home’s fire precautions. Incidents and accidents are recorded and the health and well being of each service user is monitored to ensure they are experiencing a good quality of life in a safe environment. 10 Exmoor Crescent DS0000064725.V347401.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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 10 Exmoor Crescent DS0000064725.V347401.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. Refer to Standard Good Practice Recommendations 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 10 Exmoor Crescent DS0000064725.V347401.R01.S.doc Version 5.2 Page 27 - 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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