Inspection on 18/01/07 for Washington

This inspection was carried out on 18th January 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Washington 20/03/08

Washington 12/01/06

Washington 03/08/05

Washington 17/02/05

Washington 27/09/04

Washington 02/03/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Briarlea 18a Bede Crescent Washington Village Washington Tyne And Wear NE38 7JA Lead Inspector Liz Simpson Key Unannounced Inspection 18th & 25th January 2007 10:30 Briarlea DS0000015753.V313505.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 Briarlea DS0000015753.V313505.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. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Briarlea Address 18a Bede Crescent Washington Village Washington Tyne And Wear NE38 7JA 0191 419 1867 0191 419 1867 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) Azure Charitable Enterprises Mr Philip Leslie Coverdale Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1) of places Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12th January 2006 Brief Description of the Service: Briarlea is a large detached house situated in Washington Village, owned by 3 Rivers Housing Association and run by Azure. The house is home for 6 adults with learning disabilities, 5 male and 1 female, ages ranging between 39 and 75 years. There have been no changes to the service user group since the home opened and their needs have not changed since the last inspection. Each person living in the house has a bedroom of their own with the facility to lock the door for added privacy, as well as a key to their room door. Each person also has a key to the door of the house. Everyone in the house shares the lounge, dining room, kitchen, bathroom and toilets. There are staff available 24 hours a day, seven days a week to support people in their daily lives and to provide waking night cover. A consistent approach to all areas of service users needs is achieved by a key worker system. The aim of the service is to offer the people who live there a good quality of life by promoting independence as far as possible and a valued lifestyle through access to community based activities. The fees range from £586.17 - £821.74 per week. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place over one day and was part of a scheduled unannounced key inspection. Information about the service was gathered before and during the site visit and included information provided by the manager in a pre-inspection questionnaire. Comment cards were made available to residents and relatives to get their views. Four were received by the Commission for Social Care Inspection (CSCI). One relative was contacted by phone and their views are included in the report. Time was spent talking with the Manager, some of the staff and the residents. Case tracking was used to assess the quality of the service received by residents which included looking at a sample of records such as care plans and staff records. Time was spent looking around the building and included all communal areas and two of the residents’ bedrooms. Residents were joined for lunch and observations were made of the support the staff offered to residents at lunchtime and throughout the day. The manager stated that people who live in the home prefer to be referred to as residents and this will be reflected throughout the report. What the service does well: The home is managed by a very committed manager and staff team who provide a good quality service, enabling residents to exercise a great deal of choice and independence. Residents’ needs are diverse and they are valued and respected. Relatives are free to come and visit when they want. Residents were relaxed and comfortable with members of the staff team and the staff know them well and treat them with courtesy, dignity and respect. Residents’ records are well organised, maintained and contain detailed records of the care provided. The staff support and encourage residents to contribute to their care review and planning of their care. The key worker and life plan meetings are very good ways of helping the residents to keep control over important decisions about their care, and be involved in the planning and review of their care. The home has a comprehensive induction programme for new staff. There are good training opportunities for all staff. This equips them to provide good quality care for the benefit of the residents. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 6 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. Briarlea DS0000015753.V313505.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 Briarlea DS0000015753.V313505.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 and 5 Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Good arrangements are in place to introduce prospective residents to the home. This ensures their needs can be met and the home is right for them. Current residents’ needs are regularly reviewed to a good standard. This helps to make sure the care plan consistently meets the needs and wishes of residents. The home is currently implementing a new contract called a Licence Agreement for Special Needs housing. This clearly sets out arrangements between the housing association and the residents. This helps residents to know what their responsibilities and rights are under the agreement. EVIDENCE: There have been no new residents admitted to the home recently. However, prospective residents would receive a comprehensive assessment. Arrangements will include visits to the home to enable prospective residents to get to know the staff and other residents and vice versa. Existing residents are always consulted about a prospective resident. A trial period would make sure the resident had sufficient time to decide on permanent residency. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 9 It was evident that residents care needs were regularly reviewed and reassessed by ‘key workers’. And these mirrored the needs observed by the inspector. The needs, wishes and aspirations of each resident are recorded within their ‘Life Plan’. They also detail the action taken to meet these needs and progress made. Since the last inspection a licence agreement has been drawn up and plans have been made for all residents to sign this agreement. This will provide the residents with the right information regarding their responsibilities and set out their rights under the agreement. Briarlea DS0000015753.V313505.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 Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Good arrangements are in place to involve residents in the development of life support plans. This helps to ensure their needs; wishes and aspirations are reflected in their individual plans. Residents are well supported and encouraged to live as independent a lifestyle as possible. EVIDENCE: Three residents’ records were looked at and showed evidence that the residents were involved in the development and reviews of their care plans. Each resident has a key worker and they discuss monthly all aspects of life in the home at life plan meetings. Promoting independence and choice is valued and encouraged. One member of staff said, “They deserve quality of life as individuals” and “We are guests in their house”. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 11 Other records provide further information of residents making choices about their daily routines. Issues discussed at residents’ meetings include social activities, holiday arrangements and meals. Staff confirmed that consultation with residents allows them to decide on activities of their choice, so they have control over their lives and the running of the home. Risk assessments have been carried out for all the residents. These cover areas such as assistance with personal hygiene, domestic chores, transport journeys, kitchen safety, shopping trips, pub visits and bus journeys. This means that the safety and well being of each resident, both within the home and outside the home is maintained. Also residents are enabled to lead as independent a lifestyle as possible. Records relating to residents and the day-to-day management of the home are kept securely and in line with the home’s policies on record keeping. This makes sure that information about the residents is kept safe from public access. Briarlea DS0000015753.V313505.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): 12, 13, 14, 15, 16 and 17 Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are encouraged and supported, to a good degree to lead active and fulfilling lifestyles by having a regular community presence and by accessing a range of community facilities. This will assist in them leading a full and enjoyable life. Residents are well supported to maintain personal relationships and friendships, which helps them to keep in touch and be involved in family life. Residents’ rights are respected and routines in the home are flexible and actively promoted. This can help promote a flexible service that encourages and promotes residents’ choices and preferences. Residents are clearly involved in the choice of meals and encouraged to take part with meal preparation. This helps to promote their general health and well-being. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 13 EVIDENCE: The residents are supported by staff in activities within and out of the home. Residents are also assisted to have trips out, use local shops and to go on holiday. For those residents ‘case tracked’, their individual preferences are recorded and the activities undertaken reflect these preferences, their needs and associated risks. The home has a car, so staff can take residents out on trips on a one to one basis. Residents take part in a range of activities, such as going to the pub, cafes, shopping etc. This enables them to meet with people outside their immediate home environment and prevents them from becoming socially isolated Relatives are able to visit the home at any time and are made welcome by the staff team. One relative commented “Staff friendly and lovely”. Residents are able to visit their relatives in private. Relatives are also invited to activities organised by the home, including birthday parties and Christmas events. On the day of the inspection a resident was celebrating a birthday. Staff had made this a very special event and were organising a buffet in the evening. All the comments received from relatives said they were satisfied with the overall care provided by the home. However one relative said, “Could be better kept up to date with what’s happening”. Residents and staff were joined for lunch. The meal was well presented, nutritious and taken in a congenial family setting. Residents said they enjoyed the lunch. They are consulted the previous week about the menu for the next week. Staff were courteous, encouraged conversation and consulted residents about the meal. Residents helped to clear the table and load the dishwasher. Briarlea DS0000015753.V313505.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 in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. There are good arrangements in place that promote the health and well being of the residents. This includes identifying their healthcare needs and plans being formulated to meet those needs. Medication is generally administered following good practice. However, recording and auditing arrangements need to improve to show that the residents have been given the medication that they have been prescribed. EVIDENCE: Residents have their personal and healthcare needs outlined in their ‘Life Plan’ records. Their needs are supported and met, where appropriate, in private and they are encouraged to cater for their own needs where possible. Specialist support has been sought and maintained where necessary, and multidisciplinary in put, for example from the Speech and Language Therapist and Psychologist, made available. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 15 Medication and other healthcare risk assessments have been carried out and the details available in individual records. This enables each resident to lead their preferred and chosen life style within an acceptable level of risk. There are suitable arrangements in place for the storage and administration of medicines in the home. Arrangements for the administration of medication were looked at for three residents. In one case, the loose medicines did not balance with the record. The manager agreed to review the home’s practice to ensure records accurately reflect the amount of loose medication. Briarlea DS0000015753.V313505.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 in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Information about making a complaint is clear and accessible. This contributes to residents’ and relatives’ views and concerns being voiced. It also ensures any complaints are dealt with promptly. Satisfactory systems are in place to protect vulnerable people against abuse and all staff receive training, so they can identify any signs of abuse and protect residents. EVIDENCE: There have been no complaints received since the last inspection. Information is made available to residents and relatives and gives details on how to make a complaint. It is also discussed with individual residents, so they have a clear understanding if they are not happy with any aspect of the service they know how to make a complaint. All comments received from relatives stated they were aware of the home’s complaints procedure. One relative said, “staff are approachable, no problem discussing any issues with them”. There have been no adult protection issues since the last inspection. The manager confirmed that all staff, apart from new starters have received training to ensure vulnerable adults are protected. As this is part of the core training staff receive, it is included on an ongoing programme. Briarlea DS0000015753.V313505.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 in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents benefit from good, well maintained, homely, safe and clean accommodation. This can help promote a positive image for residents, and ensure they remain comfortable and safe. Resident’s bedrooms are furnished to a good standard. This can contribute to their comfort during their stay at the home. EVIDENCE: The pre-inspection questionnaire evidenced the maintenance of health and safety records to ensure the safety and well being of the residents. These were supported with well maintained health and safety records, checked at the home during the inspection visit. The home was clean with no evidence of unpleasant odours. Communal areas are comfortable, homely and maintained to a good standard. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 18 Briarlea is a purpose built six bed roomed detached house with parking and a garden at the back. A garden project involving the residents includes a decked area with a table and chairs. Downstairs there is a kitchen, lounge/dining room, and conservatory. There are two bathrooms, one with a bath and the other with a level access shower. The laundry room was well organised and hazardous materials were stored in a locked cupboard. All bedrooms have been personalised to reflect individual choice and preference. Two bedrooms were viewed with the residents’ permission. These were clean, comfortable, homely and maintained to a good standard. The water temperature was checked in the upstairs bathroom and the temperature was 43 degrees to avoid the risk of scalding. Briarlea DS0000015753.V313505.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 in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels are satisfactory and the staff team is committed to ensuring the care and support they provide is consistent with the needs of the residents. However the use of some agency staff, to cover vacant posts, means it is not always possible to provide consistency of care The home operates good recruitment procedures to ensure residents are protected. Suitable arrangements for staff training and supervision are in place, which make sure that staff are equipped to provide a good quality service that benefits the residents EVIDENCE: Staffing rotas show that the home consistently maintains satisfactory staffing levels to meet the needs of the residents. The manager endeavours to recruit promptly for any vacant posts. However this can take time which means agency staff are used to maintain satisfactory staffing levels. The manager Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 20 tries to use the same agency staff to promote consistency of care but this is not always possible. 50 of the staff team have an NVQ (National Vocational Qualification) Level 2 or above. This ensures that residents are supported by qualified staff who can meet their needs. Other training is provided for all staff, which includes moving and handling, first aid, fire safety training, food hygiene, challenging behaviour management and protection of vulnerable adults awareness training. All new staff receive three months of induction training. This ensures new staff are competent to work with residents in all areas. Staff confirmed that the home provides a good level of training, supervision and management support. There are regular team meetings so staff can bring forward their ideas. Comments included, “excellent training”, “friendly family atmosphere” and “I love working here, everyone has limitless potential, without setting them up to fail”. Staff records show the home operates good recruitment and employment procedures. This makes sure staff are suitable to work with vulnerable people. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 21 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 in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The residents’ health, safety and welfare are promoted by a well managed home. The manager runs the home for the benefit of the residents. He has a good understanding of their diverse needs and they are treated as individuals and enabled to make choices. Robust procedures are in place to safeguard the residents’ finances. EVIDENCE: The manager and senior support worker provide supervision and support for the staff. Staff records give details of regular supervision. The manager is available for staff and residents at all times and they spoke positively about the support that is provided. He has a very good understanding of the residents’ diverse needs and is committed to making sure these are met. He said, “residents come first”. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 22 The manager confirmed that a monthly audit system had enabled him to review all aspects of the service ranging from life plans to health and safety in the home. The manager has continued to maintain evidence of proper maintenance of the home. Maintenance certificates for the servicing of electricity, electrical equipment, gas, heating and bath hoist servicing were available and up to date. Records of the regular internal maintenance of home and equipment are also kept. This ensures a safe and secure environment for the residents. This was further reinforced by the provision of health and safety training including first aid, fire training, moving and handling and food hygiene for all staff. The company has produced detailed health and safety policies and procedures and copies of these were made available for the inspection. These cover policy areas such as fire prevention and care of substances hazardous to health (COSHH). The policy guidelines are aimed at ensuring that the staff maintain safe working practices, which safeguard the safety and well being of the residents. Personal finance records for three residents showed a correct cash balance. Receipts and signatures are maintained for all transactions. Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 23 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 3 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Requirement The manager must ensure that records accurately reflect the quantity of medication administered to residents Timescale for action 01/04/07 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 Briarlea DS0000015753.V313505.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South of Tyne Area Office St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Briarlea DS0000015753.V313505.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. 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