Inspection on 29/06/09 for 32 Albert Road

This inspection was carried out on 29th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

32 Albert Road 08/08/06

32 Albert Road 02/11/05

32 Albert Road 02/11/05

32 Albert Road 04/05/05

32 Albert Road 02/12/04

32 Albert Road 26/06/04

32 Albert Road 01/05/03

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 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 32 Albert Road 32 Albert Road Clevedon North Somerset BS21 7RT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Melanie Edwards     Date: 2 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: 32 Albert Road 32 Albert Road Clevedon North Somerset BS21 7RT 01275341753 01179699000 nancy.kitson@brandontrust.org www.brandontrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Brandon Trust care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 9 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home 32 Albert Road nursing home is part of the Brandon Trust, and offers care and support services for people with learning disabilities and physical disabilities. It is a small home with capacity for nine residents. The service currently provides for six older people who have been resettled from long stay institutions. The home also provides a respite service for up to three younger people in the North Somerset area. Fees to stay at the home range from £974 to £1191 a week. 9 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Please note people who use the service have multiple disabilities and it is hard for them to express their views verbally. We spoke to three care staff and a registered nurse about their roles, responsibilities, training and development needs. We saw staff helping residents with their range of care needs. We looked at a sample of records that relate to the running of the home as well as care records. Among the records we saw were one residents assessment information and care plan,four residents medication records,menus,the complaints procedure, the staff duty rota, four staff training records and the fire log book. Care Homes for Adults (18-65 years) Page 6 of 27 We saw the home throughout. We found that the home was operating within the required conditions of registration, which we impose. The conditions of registration set out the type of care and the needs of persons as well as the numbers of persons who may stay at the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are assessed to show that their needs can be met. Evidence: To find out how effectively peoples needs are assessed we looked in detail at one residents assessment of their needs. We read an informative assessment of the persons physical mental and social needs. We saw information about the likes and dislikes of the person and their choices of social and therapeutic activities. The assessment was written in a person centred style. This is done to help staff to see the person as a unique individual, with their own wishes, thoughts and feelings about their care. We evidence that the assessment had been regularly evaluated and updated. This helps to demonstrate how well residents needs are being met by the home. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs have been assessed and generally care plans show how needs are met. However there is a lack of up to date information in some parts of care plans. Personal care is not consistently being delivered to residents in a way that best promotes their privacy and dignity. Residents are supported to make decisions and to take risks in their daily lives. Evidence: To see how well residents needs are met and how well staff support them, we read one care plan in detail. We saw a personal profile completed about the person, in this we saw the personal history of the person, information about their physical and mental health history, as well as a record of the important people such as family and friends. There was a care plan showing how to address physical mental and social needs. The information in the care plan aimed to promote the independence of the Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: person in their daily lives. There was evidence written in the records that staff had tried to include what they think are the wishes and aspirations of the person. There was also evidence that the care plan had been evaluated and updated on a regular basis. However there was a lack of up to date information in the care plan about the persons care. Specifically the persons mobility needs.The care plan said two staff are needed to help the resident with their personal care. However the nurse we spoke to said that only one person was needed. We had seen one member of staff help the person with thier needs earlier in the inspection. We saw staff helping the residents in a kind way. We saw staff speak to residents in a very warm and patient manner. We saw two staff assisting one resident in their bedroom with personal care needs with the bedroom door open. When we walked down the stairs near the bedroom the members of staff then shut the door. We discussed this incident with the registered nurse in charge. We saw two staff help one resident with their personal care in a very kind and friendly way. However the staff assisted the person and left them to wait by the lift in a wheelchair, while they helped another resident with their needs. This action could be construed as depersonalising and institutional to leave a person to wait by a lift for over twenty minutes. Residents go out with staff in the minibus regularly to go to a range of social and therapeutic activities. We saw one of the residents and staff from the home go out to a community based art group in the town. This is good evidence of how people are well supported to take risks in their daily lives. We read information included in the care plan we saw about the potential risks and hazards that the residents concerned may encounter. The care plan set out what are approaches staff should take to keep the person safe. We also read information written in residents records that showed staff were aiming to support them to maintain independence in their daily living. We noticed residents getting up at different times during the morning. This practise helps to demonstrate how residents choices and different preferences are respected. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are well supported to take part in a range of social and therapeutic activities. Residents are well supported to be a part of the community and to have personal relationships. Residents are provided with a varied well balanced diet. Evidence: We read the philosophy of care for the home,this says that as much as possible one main aim is to support people to be able to use community facilities as often as residents wish too. Good examples of how people are supported to spend time in the community include residents going out shopping, going out for walks, going for meals, Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: out or for a drive on a daily basis to areas of interest for them. In the home we saw photos of recent holidays and social events that residents had taken part in. One resident has very recently come back from a holiday to centreparcs. We saw staff talking with the resident about the holiday and it seems as if they had really enjoyed it. We were told by staff that the home encourages contact with family and friends. Some residents see their relatives regularly and we saw information to confirm this in the care plan that we read. We saw residents being supported to get up at different times during the morning. At mealtimes we saw residents being offered their preferred choices of breakfast and lunch. The staff told us that they help residents choose what clothes they would like to put on in the morning. These are good examples of how residents rights and choices are respected. We read a copy of the current four weekly menu of residents meal options. We saw a variety of dishes recorded as being available for each day. We saw some evidence that demonstrate peoples likes and dislikes are included when menus are planned. Meal choices include a range of traditional nutritional meals. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are met. The practises for the handling and giving out residents medication are not fully safe. Evidence: We checked procedures for giving out, storing and getting rid of residents medication to see if this is done in a safe way. We were concerned that when we asked for the drug cupbard keys, these were in an unlocked drawer. This means medication is not being stored securely. We looked at four residents medication records. We saw a photo of the person maintained with each record. This should ensure medication is administered correctly to the person named on the chart. The medication administration charts were legible and contained the signature of the dispensing member of staff. The reasons for any omissions had also been written on the charts. However we observed one of the care staff take two residents medication from the medicine cupboard.The medication had been put into dispensing pots by the registered nurse. We saw that the pots had each residents name on them written on a small piece of paper. We told the registered nurse that this was an unsafe way to give out medication as it may lead to a drug error. This in turn could cause significant harm Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: to residents. We saw two residents who had been given their medication in small pots,while sat at the same table,eating breakfast. The medication was with both residents unsupervised for over ten minutes. The nurse had not checked to see if the two residents had taken the medicines. This could also lead to a drug error if medication is left unsupervised near residents. The stock of medication held in the home was satisfactorily organised. Medication that was no longer required was being returned to the pharmacist. We saw staff putting aprons on to residents at meal times and not telling the residents what they were doing. This action could make a person anxious and it also suggests a lack of communication from the staff to the residents. We saw up to date information written in residents care records about preferred daily routines of the residents and particular likes and dislikes in their day to day lives. This is a really good way for staff to be able to meet residents needs in the way that is preferred by them. To support residents with their health needs the home use local GP practices. There is also specialist support provided from other external professionals including the dietician and if needed the community nurses. We saw extra information in the residents daily records that showed us staff keep a close watch on residents and observe their overall health. We saw that staff call the doctor or dentist if they are concerned about the person. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make complaints about the service. There are systems in place to protect residents from abuse Evidence: We were not able to look at the complaints record book at the inspection. We spoke to the staff on duty about how they may support residents to make complaints. The staff demonstrated an understanding of how to support people if they judged that the person concerned wanted to make a complaint. The staff conveyed to us that they advocate for residents and ensure their views were made known to the manager. We saw procedures and guidance information on the subject of safeguarding residents from abuse. This helps to protect vulnerable adults who live at the home if staff can get hold of the right information to ensure the safety and protection of residents. The staff have done training to help them better understand issues around the protection of vulnerable adults from abuse. The staff we met were able to tell us what they would do if they had concerns for a residents welfare. The staff said they would report without delay all such allegations to the appropriate senior member of staff. Care Homes for Adults (18-65 years) Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in an environment that is generally suitable for their needs. The home is clean and mostly satisfactorily maintained. Evidence: 32 Albert Road is in a residential area of the town of Clevedon. The home is a short distance from the main shopping area of the town. The home is near to bus stops,a train station, local shops, coffee shops, pubs and a church. This means residents can be part of the community easily if they want to be. The home is a four storey building and residents can use the first three floors. There is a lift in the home to help people with reduced mobility. We found the home looked clean in all areas that we saw. The environment looked to be mostly adequately maintained. However we saw two light bulbs on the ceiling lights in the dining room with no shades over them. This makes the light in the room more harsh and less relaxing for residents. The bedrooms we saw looked clean and satisfactorly maintained. All bedrooms are for single use. We saw that rooms had been decorated in different colours. We saw that Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: residents had their personal possessions in their rooms. We saw residents sitting at the dining room and in the lounge looking really relaxed in their environment. We saw bathrooms near to communal areas and bedrooms. We saw that the bathrooms and toilets were clean. We saw hand towels and soap to help reduce risks from cross infection. Care Homes for Adults (18-65 years) Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a sufficient number of staff. there is a need for staff supervision in the home, to benefit resdeisnt and the staff. Staff do training to support them in the work they do. Residents would benefit if staff did training in communicating effectively with residents. Resdiens are protected by the homes recrutment procderus Evidence: We did not check recruitment procedures during the inspection. Brandon Trust keep their staff employment records at the head office. We do regular checks of staff employment files at the Trust head office to ensure they are following safe recruitment practises, that protect people who use the service. We checked the staff duty rota for three weeks of June to find out how many staff support residents to meet their needs. There are a minimum of four staff on duty for a day shift consisting of at least one registered nurse and care staff. There are two staff at night consisting of one registered nurse and one care assistant. We observed Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: residents being supported by the numbers of staff on duty. Based on the evidence from the inspection the number of staff on duty at any time is the minimum number necessary to ensure residents needs are being met. The staff we met gave us different answers when we discussed staff supervision and support with them. We were told that staff do have regular support and supervision. We were also told that some care staff had not had formal supervision for over twelve months. Regular staff supervision is a really good way of improve the overall performance of staff and also the overall quality of the care that residents receive. The training records demonstrated staff had attended training relevant to the needs of the residents over the last twelve months. This should help ensure peoples needs continue are met by trained and knowledgeable staff. Residents could beneift if staff we observed at the inspection did training on improving their communication skills with residents. We refer to our previous comments about staff and the way we saw residents being helped with their personal care. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The change in management structure in the home could be impacting on the overall service that residents receive. There are system in place to monitor the quality of the service in the home . Residents health and safety is protected. Evidence: Ms Kitson is a qualified nurse specialising in caring for people who have learning disabilities. She has a number of years of experience working with people who have very complex needs. She is registered with us as the manager of the home. This demonstrates Ms Kitson is considered suitable and qualified to fulfill the role of registered manager. Since April of this year, Ms Kitson has been given the additional responsibility of running a supported living service and another care home. This change in management structure could have had an impact on the overall rating of 32 Albert Road. Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: The staff told us that there are staff meetings held in the home. The staff we met said that it had had an impact on the overall running of the home to no longer have a registered manager working full time in the service. We were told that before the change in management structure,Ms Kitson was a very hands on manager who worked closely with the staff and the residents. We saw evidence that monthly monitoring visits of the home, that must be carried out by a representative of Brandon Trust are being done. The records we saw demonstrate that the designated individual responsible for the visits spends time consulting with people and their representatives and observing staff. We saw evidence in the staff training records that staff do regular training in health and safety subjects including first aid and moving and handling practices. This should help protect residents if staff are knowledgeable and trained in health and safety principles and practices. We saw records that showed staff are checking the temperature of all high risk cooked food before food is served to people so to make sure it is hot enough and safe. We saw that the fire logbook record showed the required weekly and monthly tests of the fire alarms and the fire fighting equipment were being carried out and were up to date. We saw a record of the regular checks of the environment. These checks show a member of staff audits the health and safety of the Home environment on a regular basis. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 6 15 Care and well being of residents. Care plans must show how needs are to be met. 30/06/2009 2 6 15 Residents needs must be met 30/06/2009 in a manner that respects dignity and privacy. Dignity and privacy of residents. 3 20 13 Health and wellbeing of residents. Medication must be given to residents in a way that is safe. 30/06/2009 4 20 13 Health and Safety. Medication must be stored safely. 30/06/2009 5 24 16 There must be suitable 29/07/2009 lighting in the home .Specifically ensure the exposed light bulbs in the dinning room are covered by lampshades. Wellbeing of residents. 6 36 18 Staff must be properly supervised . Staff development. 30/06/2009 Care Homes for Adults (18-65 years) Page 25 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 6 6 32 Ensure staff communicate effectively and respectfully to residents when helping them with their care needs. Maintain privacy by shutting bedroom doors when providing personal care. Staff should do training in effective communication with residents. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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