Inspection on 21/04/05 for 26 Ladyfield Road

This inspection was carried out on 21st April 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

26 Ladyfield Road 10/09/07

26 Ladyfield Road 19/07/06

26 Ladyfield Road 12/10/05

26 Ladyfield Road 15/11/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Ladyfield Road (26) 26 Ladyfield Road Chippenham Wiltshire SN14 0AL Lead Inspector Elaine Barber Unannounced 21st April 2005 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 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 Stationary 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. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ladyfield Road (26) Address 26 Ladyfield Road Chippeham Wiltshire SN14 0AL 012490654451 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tranquility Care Mrs Sharon Wright-Palmer Care Home 3 Category(ies) of 3 LD Learning Disability registration, with number of places Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Manager, Mrs S Wright-Palmer, must commence the Registered Managers Award within one month of the date on which the first service user is admitted to 26 Ladyfield Road and must achieve the awared within one year of this date. Date of last inspection 15th November 2004 Brief Description of the Service: 26, Ladyfield Road is a semidetached house within walking distance of Chippenham town centre allowing easy access to all local amenities. The home provides a community based service in a domestic environment. The home is currently registered for three adults with learning disabilities. The home is owned and staffed by independent providers Mr Everet Palmer and Mrs Sharon Wright Palmer. Mrs Wright Palmer is the registered manager and there are additional support workers to ensure that one member of staff is on duty at all times. The accommodation consists of a large living room with a dining area, a kitchen and three single bedrooms, which can be individualised. Furnishings and fittings are domestic in style. The objectives of the home are to enable service users to maximise their potential and to live as independent a life as they are able. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection and preparation took ten hours. The inspector spoke to two people living in the home, a member of staff and the manager, read records, including care plans and staff files, and looked at the accommodation. Since the last inspection there has been one additional visit to investigate several complaints by a relative of a person who has moved out of the home. What the service does well: What has improved since the last inspection? What they could do better: Care plans need to include how religious and health needs are to be met. Medication received into the home and returned to the pharmacist must be recorded. Unused medication must be returned to the pharmacist. People should be offered the option of a comfortable chair in their room. The washing machine must be moved from the kitchen to prevent cross infection. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 6 When a complaint is made the providers must respond within twenty eight days. Staff should receive training about abuse awareness. Some policies need to be revised to suit the needs of the home particularly for recruitment and abuse. A system must be developed to review the quality of care. Risk assessments should be developed to protect staff and people living in the home from general hazards. 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. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 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 standard(s) 1, 2 and 5 People have the information they need to make an informed choice about moving into the home. Their individual needs are assessed before moving into the home and each person has an individual written contract. EVIDENCE: There was a clear statement of purpose containing all the required information. It stated the aims and objectives of the home, which were to provide a stimulating environment so people can live as full lives as they wish. There was also a clear service user guide but this needed to include the qualifications and experience of the staff. The manager makes people aware of the inspection report. She has explained the service user guide and information to one person and communicated the information to other with the help of parents. There was a statement in the statement of purpose that people are only admitted after a full assessment. There were two people living in the home. One had a social work assessment and an occupational therapy assessment. The other had a social work assessment and care plan. Each person had a contract with their purchasing authority and the home. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 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 standard(s) 6 and 9 Service users could not be confident that their assessed needs would be met as action to meet health and religious needs was not reflected in their individual plans. Service users were supported to take risks and their independence was encouraged. EVIDENCE: Each person had a care plan based on the social work assessment. The plans covered personal social and health care needs. The actions to meet personal care needs were very detailed and there was a weekly plan of social and leisure activities. There was a previous requirement to include health needs in the care plans. A new health section had been included. However this identified the needs but did not include a plan to address the needs. The plans need to include how to manage health conditions and arrangements for accessing the GP, dentist optician and other health professionals. The social work assessment identified some needs in relation to religion and health care which were not addressed in the care plan. There was no evidence in either plan that the person and their family had been involved in developing it. The manager reported that they discussed the plan with the person and consulted their family but their was no record of this. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 10 One of the plans was reviewed after four months and the other plan was not yet due for review. Risks were identified in the social work assessments and occupational therapist risk assessment. There were risk assessments for identified risks such as hot water, bathing and using the iron, with action to reduce risks without limiting freedom of choice. There was a written procedure about absence. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 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 standard(s) 12, 13, 15, 17 People took part in activities, which suited their interests and were age appropriate. They were encouraged to be part of the local community and to have appropriate personal and family relationships. People were offered a healthy diet, which met their health needs and they enjoyed their meals. EVIDENCE: Each person had a programme of daytime activities. One person attended a resource centre every day. The other had a programme based around their independence needs, including household tasks, music and TV. They attended a cookery class one day a week with the option of another session. Independence was promoted within people’s capabilities. Staff were encouraging one person to participate in more activities. One person had regular contact with family with regular visits home. They went to church with their family. The other had tried church but chose not to attend regularly. People attended a club. Staff took people shopping locally and to Bath, Bristol and Swindon. One person regularly visited their home town. The other had social activities through their day service. Records of food served showed a varied and balanced diet was presented. There was no set menu and staff said that people chose what they wanted to Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 12 eat on daily basis. A special diet was catered for. People tended to eat in the dining area. One person said that they liked the food and were involved in meal preparation. People ate at their own pace. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 13 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 standard(s) 18, 19, 20 People received personal support in a way that they preferred and required. It was not clear how physical and emotional health needs were being met. The system of medication recording and management did not ensure that people were protected. EVIDENCE: Care plans included people’s preferences for personal care and support. The plans specified how personal care needs were to be met. Personal care took place in the privacy of the bathroom or bedroom. People had individual clothing of their choice. Appropriate aids were provided following occupational therapy assessment. Support from specialists, including a psychologist and psychiatrist, was provided through the local community team. People saw the GP, dentist, optician, community nurse and podiatrist although arrangements for accessing these were not recorded in the care plans. One person had a health need but how this was to be addressed was not recorded in the plan. A referral was made to the GP if health needs changed. There were some continence needs and the continence nurse had been involved. There was a medication policy and procedure. Medication was stored in a locked cabinet. When medication was prescribed this was recorded in the care plan. There were records of administration of medication but not medication received into the home or returned. There was some medication belonging to a person who had left the home. This should be returned to the pharmacist. All staff administered medication after receiving training and being deemed Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 14 competent by the manager. A referral was made to the GP if there was concern about medication. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 15 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 standard(s) 22, 23 The complaints procedure was not working to ensure that the views of relatives and people living in the home were listened to and acted upon. Staff training was not sufficient and the procedure about abuse was not robust enough to ensure that people were protected from abuse, neglect and selfharm. EVIDENCE: There was a complaints procedure incorporated into the statement of purpose and service users guide. There had been several complaints from relatives of a previous resident. An additional visit was made to the home to investigate these. Several of the concerns were not upheld and there was insufficient evidence to resolve two. Concerns about lack of information about policies on alcohol, the safety of money, the cleanliness of a bedroom, relatives not being given information about healthcare and a complaint not being responded to were upheld. The proprietors had taken measures to address these issues. However, there was another recent complaint that the manager had not responded to within 28 days. Information from records kept of complaints and responses upheld this complaint. There was a policy about abuse and a ‘No Secrets’ leaflet about the local multiagency procedures for dealing with allegations of abuse. The policy did not link with this procedure and needs to include what action staff should take if they receive an allegation of abuse and how to report it. Staff had not received training about abuse awareness. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 16 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 standard(s) 24, 25, 26, 27,28, 29, 30. People lived in a homely, comfortable, clean environment. They had sufficient communal space to pursue their leisure activities. They had bedrooms which were comfortable, suited to their lifestyles and promoted their independence. Appropriate aids were provided to promote independence. Current laundry arrangements pose an infection control risk. EVIDENCE: The home was in a residential area close to local shops and amenities. The building was in keeping with other houses in the street. There was a large lounge dining room, a kitchen, an office and sleeping in room and a large garden. The environment was homely and domestic in style with sufficient communal space. The accommodation was safe, comfortable, bright, cheerful, airy, clean and free from offensive odours with sufficient light, heat and ventilation. All parts of the home were accessible to the service user. The home met the requirements of the local fire service, environmental health and building control. There was regular maintenance. The radiators were covered and new fire doors had been installed. These detracted slightly from the homely environment and could be improved by painting or varnishing. There were three single rooms all in excess of ten square metres of useable floor space. The rooms were lockable and contained furniture appropriate to Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 17 the people’s needs except for comfortable chairs. One person said that they liked their room and they had all the furniture they needed except they would like a comfortable chair. There was a bathroom with shower and toilet upstairs and a shower with toilet downstairs. There were grab rails in the bathroom and a stair gate provided following an occupational therapy assessment for one person. There was a washing machine in the kitchen and a tumble drier by the back door. The washing machine needs to be removed from the kitchen so that soiled linen is not washed in areas where food is being prepared. Laundry was done promptly when clothes were soiled and people had a large amount of clean clothes. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 The people living in the home were supported by a qualified and experienced staff team to meet their assessed needs. The people were protected by the home’s recruitment practices despite shortfalls in the policies and procedures. EVIDENCE: The rota showed that there was one member of staff on duty at all times. There were three members of staff as well as the manager and proprietor. Two members of staff had National Vocational Qualification Level 2 and one had a BTec Higher National Certificate in Care. They had previous experience of working in care. They had training in first aid, food hygiene and manual handling. Staff undertook care and domestic tasks. Specialist services were accessed through the local community team for people with learning disabilities. Two new members of staff had been recruited since the last inspection. Two written references, Protection of Vulnerable Adults and Criminal Records Bureau checks had been obtained for both. However, the recruitment procedure referred to equal opportunities but did not reflect the recruitment practice. The people who lived in the home were consulted about the appointments and included in the decision-making. Two staff had a copy of the General Social Care Council code of conduct and practice and the manager was obtaining a copy for the other person. There was one volunteer who had Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 19 ahd a CRB check and the manager was taking up references. Staff received statements of terms and conditions and had a three month probationary period. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 40, 42 The manager has appropriate qualifications and training. People’s views are not yet canvassed to underpin a review of the quality of care and the development of the home. People’s rights and best interests are safeguarded by some of the home’s policies and procedures but others do not reflect the needs of the people living in the home. The health, safety and welfare of service users are promoted and protected by the health and safety checks and measures. However there are some risks to staff and service users because general hazards are not assessed. EVIDENCE: The manager has a Registered General Nursing qualification and had completed an introductory management course. It was a condition of registration that she must register for the Registered mangers Award within a month of the admission of a person to the home and complete the award within a year of that date. She had registered for the award as required and was on target to complete by that date. The manager also had training in first aid, food hygiene, manual handling. Managing aggression, fire safety and introductory management. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 21 There was a previous requirement to develop a system for reviewing and improving the quality of care. This still needed to be developed. The manager used policies and procedures from a care home manual. There was a previous recommendation that the manager should adapt these to reflect the needs of the service. Some had been revised and the manager was working through the others. There was another recommendation that the manager should develop risk assessments for safe working practices and general hazards. The manager had developed a policy about risk assessment but not yet completed the assessments. Staff had received training in manual handling, first aid, food hygiene, fire safety and health and safety. Induction training included health and safety. The electrical wiring was checked two years ago. The boiler and central heating system were serviced annually. The laundry equipment was under warranty. Radiators were covered and the windows were restricted. Water temperatures were regulated and were taken monthly and prior to bathing and showering. There was information about COSHH. Records showed that the fire precautions were being maintained. The fire procedure was displayed. There was an accident book but there had been no accidents to record. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 3 Standard No 22 23 ENVIRONMENT Score 1 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 3 3 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x x 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ladyfield Road (26) Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 1 2 x 2 x D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 23 Yes 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. 1. 2. Standard 6 20 Regulation 15-1 and 2 13-2 Timescale for action The individual plans must include 30/5/05 information about how healthcare needs are to be met. A record must be kept of 21/4/05 medication received into the home and returned to the pharmacist. Unused medication must be returned to the pharmacist The proprietors must ensure that 21/4/05 any complaints about the service are fully investigated and responded to within 28 days. The washing machine must be 31/7/05 re-sited in a position where food is not stored, cooked or eaten. The registered person must 30/6/05 establish and maintain a system for reviewing and improving the quality of care. The system must involve consultation with people who use the service and their representatives. The registered person must produce a report of their review and send a copy to the Commission for Social Care Inspection and to the people using the service. Requirement 3. 22 22-3 4. 5. 30 39 13-3 24-1, 2 & 3 6. Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 1 6 23 Good Practice Recommendations Te service user guide should also include information about the relevant qualifications and experience of the staff. When people are involved in developing their care plan a record should be made. When people are able they should agree and sign the plan. The policy about abuse should link with the multi-agency procedure and contain information for staff about how to report an allegation of abuse. Staff should receive training about abuse awareness. The general décor could be improved by painting the fire doors and radiator covers. Each person should be offered option of two comfortable chairs in their room. Chairs should be provided if requested. The outstanding policies and procedures need to be adapted to reflect the needs and type of the service. The recruitment procedure should reflect the recruitment practice. It would be good practice to produce an annual development plan for the home reflecting aims and outcomes for the people using the service. The plan should be kept under review and an audit of the service should take place at least annually. Risk assessments should be conducted for all safe working practices and general hazards in the home. The findings should be recorded. 4. 5. 6. 24 26 34, 40 7. 39 8. 9. 42 Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB 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 Ladyfield Road (26) D51_S53430_LAYDYFIELDRD_V207282_210405Stage4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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