Inspection on 30/05/06 for 17 Jerome Close

This inspection was carried out on 30th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

17 Jerome Close 17/05/07

17 Jerome Close 15/02/06

17 Jerome Close 10/11/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 17 Jerome Close 17 Jerome Close Eastbourne East Sussex BN23 7QY Lead Inspector Lindy Latreille Unannounced Inspection 30th May 2006 09:20 17 Jerome Close DS0000021453.V290991.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 17 Jerome Close DS0000021453.V290991.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. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 17 Jerome Close Address 17 Jerome Close Eastbourne East Sussex BN23 7QY 01323 767399 01323 740846 jamesjemini@aol.com www.jemini-response.co.uk Jemini Response Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr James Edwards Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of young adults to be accommodated is three (3). The young adults accommodated will be between sixteen (16) and twenty-five (25) years on admission. Only young adults with a learning disability can be accommodated. Date of last inspection 15th February 2006 Brief Description of the Service: The home is situated in a residential estate on the outskirts of Eastbourne and is close to local shops, bus routes and community facilities. The detached property has three bedrooms. A lounge-dining room, cloakroom, kitchen, staff lavatory and third bedroom on the ground floor. On the first floor there is a bathroom with lavatory, two bedrooms and an office. There is a triangular shaped open front garden where additional parking space has been added. The rear garden is enclosed by perimeter fencing and is grassed with a small paved area near the home and a fenced and gated area that can enclose a paddling pool at the furthest end of the garden. The home is one of two owned by the proprietor in the road; and the proximity of the sister home allows for joint activities to be planned and take place. The home is registered for young people with disorders within the autistic spectrum and challenging behaviour. The proprietor intends that the young people in the home will be able to remain living there throughout their lives. Referrals are usually through professional contacts. Current fees are £2,000 - £2,400 per week. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection between 09.20 and 15.45.There were three members of staff on duty organising half-term activities for two young people and the routine attendance at an adult day centre for another. A worker from the adult service spoke of his experiences with the home’s staff whilst supporting one of the young people in the day centre. The Registered Manager arrived within a short time and all staff were consulted during the day. Only one of the young people is verbal but the Inspector did speak to all the young people and their attention to the conversation and their body language, and speech where present, was positive and relaxed. Documentation seen included care plans, daily records, incidents, accidents, monthly reports to social workers and a tour of the service was done. Social workers were contacted to give feedback but did not return the calls. What the service does well: What has improved since the last inspection? The requirements of the last inspection have been mostly met, the inspection taking place before some of the timescales for action. As yet the Registered Manager hours in the home are not recorded, but a new monitoring (swipe) machine that will record all staff attendance at the home is to be purchased. The weekly and monthly quality assurance is better regulated. Laundry is managed following new policy. Food supplies are managed independently of the sister home. Staff conduct has been addressed at the staff meetings. Recruitment meets required standards. Supervision schedules are in place for all staff. Staff training to achieve care qualifications, and contact has been made with Learning Disability Adult Framework (LDAF). There is a plan of improvements know to the owner/Registered Manager and discussed with staff. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 6 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. 17 Jerome Close DS0000021453.V290991.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 17 Jerome Close DS0000021453.V290991.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. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to explain to professionals, families and prospective residents about the service at the home and how this can meet needs. EVIDENCE: Information about the service is available and reviewed annually. The residents’ guide is available in widget presentation. The home does not advertise, as the ethos of the home is that it is a home for life for the young people placed. The registration has been changed, from a children’s home to an adult service, to be appropriate to the ages of the young people. Consequently the service is not intending to admit in the foreseeable future. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 9 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. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plan is comprehensively reviewed for each young person monthly, and the young people are aware of their monthly goals. EVIDENCE: Comprehensive daily records record the holistic health and outcomes for each day. These records are drawn together to a monthly review that looks back over the past month to activities, education, achievements and behaviour. This is sent to each social worker and identifies the goals and timetable for the coming month. This monthly review is a sound guide to staff as to how to best engage with the young people. The young people use Makaton sign language and Picture Enhanced Communication System (PECS) and staff described their increasing abilities to communicate. Given the extreme challenge of communication for the young people staff work hard to involve them in choices in the daily routines and their care. This can only be at a basic level and understanding their comprehension of having their own needs met is difficult to assess. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 10 The young people follow an individual weekly timetable that includes a wide range of activities in different community venues and for which there are risk assessments in place. The young people are encouraged to take part in the domestic activities that they are capable of doing such as cooking and vacuuming. The young people are well known in the local community attending leisure facilities, shopping, eating out and going to the pub and these experiences increase their social skills and confidence. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 11 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): 12,13,15,16 and 17. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each young person has a wide range of activities in the local community in a weekly timetable; these are constantly reviewed to enhance the residents’ quality of life. EVIDENCE: Two of the young people are at school and one young person attends an adult service daily during the week. A support worker from the adult service was at the home during the early part of the morning to accompany the carer and the young person to the adult service. This support developed from observations that settling into a different environment was causing an increase of challenging behaviour linked to stress. The outcomes now are much improved with behaviour and body language mostly acceptable. The Registered Manager’s awareness of the needs for consistency and routine was a major factor in the arrangement being set up and the positive outcome for the young person. There is close liaison with each school to enable consistency, and care plans demonstrate this. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 12 Each young person has a weekly timetable of activities and PECS symbols remind the young person on each appropriate day. There are many occasions when the young people are using the community facilities and this has, over time, enabled the development of social and intellectual skills. The service has its own transport and on some occasions activities are planned for the residents of 17 Jerome Close and the sister home at 41 Jerome Close. Some summer activities involve the near neighbours and the service is aware to reduce the nuisance of parking and noise. Each activity that is undertaken is reviewed afterwards; to establish if this still meets the young person’s needs and to ensure there remains a positive outcome. Each activity record is holistic and records kept gave a good overview of the past three months for each young person. Contact with parents, families and friends are fully facilitated by the staff and where necessary organised in consultation with social workers. All known contact is timetabled and so each young person would have a visual and verbal prompt to remind them. One young person whose behaviour around one member of staff gave cause for concern was the focus of a professionals meeting to draw up an appropriate strategy of management. This concern has now passed and the strategies ensured a positive outcome for the young person. The young people are the focus of the daily routines and included in decision making as where possible. Staff encourage private or personal time as behaviour indicates thereby developing an understanding of expectations within the home. The residents have access throughout the home but need one to one supervision unless they choose to go to their bedrooms. The young people are included, where possible and practical, to be involved in meal preparation, laying the table and removing dishes to the kitchen. There are no planned menus but the Registered Manager confirmed that the staff prepared meals to an unwritten menu some of these are home cooked. Though staff felt that the young people had a choice of meals they also agreed that meals were prepared that the young people liked. Meals served are recorded in each young person’s daily records. There has not been an audit trail to ensure the quality, over time, of well-balanced, nutritious meals to underpin health and behaviour. The dietician has been involved in managing the needs of two of the young people where certain foods needed to be reduced. A reflection of the meals taken over each month, especially where patterns of behaviour are trying to be established, could clarify the situation. As the staff work at present to the unwritten menus it is possible that they may not be fully allowing the residents to explore new tastes or textures. A development of seasonal menus with the input of the young people could further enhance their choices. One young person, who is known to take food from any plate in the home or when out for a meal, does not have a risk assessment or managing strategy in place, 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 13 other than to block his path and verbally reproach him. As his behaviour was well known to staff and there had been no change over time a strategy is needed to manage and educate the young person further. 17 Jerome Close DS0000021453.V290991.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. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health of the residents is well managed by staff through personal care and observation, thereby enhancing their quality of life. EVIDENCE: The young people are encouraged to be hygienic in their daily lives and to wear clean clothes. Staff try to ensure that the young people wear similar, appropriate clothing to others of their age and care is taken with hair cuts as well. Staff supervise closely but offer privacy and independence for intimate personal care. The Family Intensive Support Services (FISS) offer guidance to staff and one to one support for the young people in their preferred method of communication. Staff are informed and provide individual care for each young person. Where necessary outside professionals are contacted and social workers are kept informed. The Registered Manager explained that finding a dentist at present was extremely difficult but he would be following up a link from a previous placement for one young person; he was also aware of an emergency dentist service locally. One young person is given to bouts of very challenging behaviour and a meeting of a parent, teacher and social worker took place recently at the home to discuss this. There is a management strategy and 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 15 guidance to staff in place, and action has been taken to prevent personal damage within the young person’s bedroom. Staff have received training in the administration of medication and all medicines given are signed for by two people. None of the residents are selfmedicating. When a medication, other than a homely remedy, is administered the remaining pills left in the bottle should be counted. All medication is ordered and received back into the home and recorded appropriate. Further training in medication is arranged for later in June 2006. 17 Jerome Close DS0000021453.V290991.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. Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints have been managed according to procedures; the young people are protected from abuse by knowledge and observation of staff, which ensures their safety. EVIDENCE: Observation is the main strategy used by staff to understand if the young people are unhappy about any aspect of their lives. When this is observed staff record their efforts to understand the situation, in conference with other professionals when necessary. Discussion with the Registered Manager did identify that there is no agreed system that address the areas of concerns or complaints with the young people specifically as staff know that their behaviour is an indication that all is not well. Development of a more proactive approach could develop the young people’s communication skills further, and be preventative in emotional stress. Staff training in adult and child protection has taken place this year and staff are aware of their responsibilities and detailed record keeping support the care taken to protect the young people. The home had a member of staff that has followed Non-violent Crisis Intervention, a behaviour management strategy that focuses on de-escalating procedures so that restraint is very seldom, if ever, used. A discussion took place following an observation when a young person wanted some food that another young person was eating as a snack. A member of staff stood in his way, which would be construed as a restraint. Following the conversation it was clear that staff frequently did this under similar circumstances, but it was not perceived as a restraint and so was not recorded as such. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 17 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 and 30. Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Though there has been some investment in the fabric of the service improvements need to be made in relation to cleaning and hygiene to provide a safe and comfortable environment for the young people to live in. EVIDENCE: Externally the home was looking well cared for. Internally there has been some new investment in furniture in the lounge and, new carpets where needed. The young people’s rooms are adequately furnished to meet their needs but do not have en suite facilities, as agreed at the point of registration. Repairs are quickly done once identified and reported. As the young people do not have physical or sensory needs there is no specialist equipment. There is no odour in the home and the kitchen was clean and tidy. Some attempt was made early in the day to vacuum and tidy the lounge with one of the young people but the stairs, landing and hallway remained grubby. The staff lavatory was unclean and the waste bin had no lid, and in the young people’s bathroom the waste bin did not have a lid on; it had been left on the 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 18 floor. The management of infection control is essential in a care home. Staff must be vigilant in their observations as they are responsible for the cleaning of the home. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 19 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): 32,34 and 35. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff are an enthusiastic team and work positively to improve the quality of life for the young people. EVIDENCE: Of the staff team of eight four are full time and four part time, only one is qualified in care. Three staff are awaiting the outcome of the final assessment on the childcare qualification that they following and two others are progressing well. The Registered Manager confirmed that recruitment is now improved with all checks in place before staff begin work unsupervised. The protection of vulnerable adults (POVA) and protection of children and young adults (POCA) are in place for all staff. There is a wide range of training offer by the service to all staff, who are enthusiastic to gain skills in their area of work. Induction has recently been updated and clearly guides new staff in the expectations of their work within the service. The Registered Manager has made links with the Learning Disability Aware Framework (LADF) to see where this can be linked into the training for staff. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 20 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): 37,39 and 42. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is developing leadership skills in the running of the home and staff are demonstrating an awareness of their roles and responsibilities to meet the needs of the young people. EVIDENCE: The Registered Manager has completed his Registered Managers Award. He is clear about the ethos of the service and staff are aware of his hands on skills and knowledge in areas of care for the young people. The Registered Manager attends training with his staff and this supports the exchange of knowledge and practice within the home. Quality assurance is more thoroughly managed by a senior in the home and the Registered Manager ensures that he countersigns the weekly and monthly audits to maintain consistency. Questionnaires are sent to parents, teachers, Family Intensive Support Services (FISS) team and social workers to establish 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 21 feedback and inform the management of the home to enable the best outcomes for the young people. Response to requirements has been within the timescales set. The Registered Manager has made sure that all staff have had access to training to enable their understanding of safe working practices. Two members of staff have attended fire prevention officer training and are able to train colleagues. Fire prevention equipment is maintained and drills are held at appropriate regular intervals. 17 Jerome Close DS0000021453.V290991.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 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 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 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X 17 Jerome Close DS0000021453.V290991.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. 2 2. 3. 4. 5. Standard YA17 YA20 YA22 YA23 YA30 YA32 Regulation 16(2)(i) 13(2) 22(2) 13(7) 13(4)(c) Requirement That menus are developed with the young people. That medication is routinely counted. That a method of addressing complaints is developed to meet the needs of the young people. That when restraint is used it is recorded. That the home is maintained in a clean and tidy manner. Timescale for action 30/07/06 30/07/06 30/08/06 30/07/06 15/07/06 15/12/06 18(1)(c)(i) That 50 of staff are qualified in care at level 2. 18(1)(a) That staff are qualified to meet the needs of young people with learning difficulties. 6. YA35 15/12/06 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 Good Practice Recommendations DS0000021453.V290991.R01.S.doc Version 5.2 Page 24 17 Jerome Close 1. Standard YA1 That 80 staff working with 16 and 17 year olds are qualified to National Vocational Qualification level 3 in Caring for Children and Young People. 17 Jerome Close DS0000021453.V290991.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 17 Jerome Close DS0000021453.V290991.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. 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!