Inspection on 20/06/05 for 340 Wilson Avenue

This inspection was carried out on 20th June 2005.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

340 Wilson Avenue 12/10/06

340 Wilson Avenue 02/11/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 340 Wilson Avenue Rochester Kent ME1 2ST Lead Inspector Sue McGrath Announced 20 June 2005 9.30am 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. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 340 Wilson Avenue Address 340 Wilson Avenue Rochester Kent ME1 2ST 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) Care Home 3 MCCH Society Limited Category(ies) of LD Learning Disability (3) registration, with number of places 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: 340 Wilson Avenue is registered to provide care and accommodation for three adults with learning and physical disabilities. It is managed by MCCH Society Ltd. The home is situated in a quiet residential area close to the town of Rochester. Local shops, a post office, and pubs are in walking distance. Service users accommodation includes one single bedroom and one shared room. Bedrooms have been adapted to meet their individual needs. In addition the building has several adaptations (a lift, grab rails, an assisted bath) and an open plan communal area on the ground floor to enhance accessibility and promote independence.There is a large landscaped garden at the rear of the building. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 20thth June 2005. One inspector was in the home and the main focus of the inspection was the general environment and the well being of the residents. During the inspection documentation and records were read, including care plans. A tour of the building was undertaken; the residents were spoken to and involved where possible. Time was also spent talking to staff and the management team. The management of the home had recently transferred from MCLS to MCCH Society Ltd and the inspector was aware that all new procedures and policies had been put in place and that staff needed time to familiarise themselves with all of them. What the service does well: What has improved since the last inspection? The ramp leading to the garden has been removed. Staff files are held securely within the home. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 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 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 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) 1,2,3,4,5 Prospective residents are not provided with the information they need to make an informed choice about moving into the home. Residents’ benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Residents and families also benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. Prospective Residents can be confidant the home would meet their needs and aspirations. EVIDENCE: Due to the recent change of provider the homes does not have a Statement of Purpose or a Service User Guide. Time was spent with the manager discussing the format and contents of any proposed documents. This was not seen as a deliberate attempt not to comply with the regulations, but clearly these documents must be produced and approved as soon as possible. The assessment process was discussed, as the home had not had any new residents for some time. The processed discussed would provide the home with adequate information on which to make a judgement over whether they could meet the prospective residents needs. The process of admission was also discussed, with prospective resident being given the opportunity to visit several times and then to stay overnight and to meet with other residents to 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 9 ensure everyone was comfortable with each other. It was clear that the manager thought it was vital that the new resident fitted in well with the existing residents. Information seen on care plans confirmed that current residents aspirations and needs had been assessed and documented. Staff were seen to communicate effectively and appropriately with the residents and were aware, when spoken to, about the individual’s preferred mode of communication. Training records of the staff on duty at the time of the inspection and observation of their practise, demonstrated that they had the skills and experience to care for the residents at that home. However further assistance from specialists with in-depth knowledge of caring for residents who are registered blind, might improve aspects of life for these residents. Contracts / statements of terms and conditions were currently being written by the new provider. The residents had previously held contracts with MCLS. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 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 standard(s) 6,7,8,9,10 Residents’ benefit from having their assessed and changing needs reflected in their individual plan. Detailed risk assessments are in place to ensure identified risks are minimised. Some staff shortages during the evenings places residents at risk and does not promote a full choice of retiring times. Resident’s benefit from a robust confidentiality policy. EVIDENCE: All of the care plans were viewed and were found to be comprehensive and regularly reviewed. The manager drew up the plans with the key worker from information gained from formal assessments and with working closely with the residents. The levels of communication difficulties experienced by the residents prevent verbal or written agreement from them regarding their individual plans. Residents were able to indicate on what they do and do not want to eat, but this can only be done by non-cooperation. Staff were aware of residents preferences over food. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 11 Concerns were raised over the time that residents go to bed as the home currently only has one member of staff after eight pm. It is advised that two members of staff are employed until 10pm or until all residents have gone to bed. The manager agreed to reconsider the rotas. Decisions made regarding taking part in activities were based around known preferences of the individual resident. Discussion with the staff and manager during the inspection and direct observation of working practise demonstrated an in-depth knowledge of residents likes and dislikes. None of the residents were able to use speech or sign language, so with this limited communication it would be difficult for the staff to ensure the residents have the opportunity to contribute to the day to day running of the home and in them contributing to the development of reviews of policies. Specific policies for the home are based around known and assessed needs of the residents. Detailed risk assessments were seen which identified specific risks to individual residents and gave clear direction to staff to enable them to minimise the risk. Staff spoken to were aware of the policies about confidentiality and the manager confirmed that this was an important part of new staffs induction. It was advised that more information is sought from other professionals regarding assisting the current residents to improve their communication and daily living skills. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 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 standard(s) 11,12,13,14,15,16,17 Resident’s benefit from having the opportunity for personal development with their daily living skills and have appropriate level of leisure activities. Residents also benefit from being part of the local community. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The resident’s benefit from the appetising meals and balanced diet offered by the home. EVIDENCE: It was evident throughout the inspection that residents were well supported to maintain their individual living skills, and their social and emotional skills. Where possible residents were seen to be encouraged to be independent in some tasks. As two of the residents are registered blind, input from KAB (Kent Association for the Blind) is being explored and the manager is hopeful that this could improve communication skills and therefore enhance daily life. Staff would also benefit from further training in sensory skills. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 13 Further education and employment opportunities are not appropriate for the current residents, however they are involved with a range of leisure activities. These activities include visits to the Hydro pool, attending Mencap, going for walks and visiting families. Visits to their banks and shopping are also encouraged. One resident is awaiting assessment for attendance at the Balfour centre and the sensory unit. Due to the level of disability within the home, staff have decided to offer day trips out rather than a weeks holiday as some of the residents would not be able to cope with being in a different environment. Residents were seen manoeuvring around the room by touch and a different environment would prevent them from doing this. Other planned activities for the summer are barbecues and coffee mornings with other resident from other MCCH homes. The manager stated that the residents had good relationships with the local community and neighbours. Staff explained how two of the residents had family in another home and that regular visits were encouraged. Other family visits are also encouraged and organised by staff. Some opportunities are made available for residents to meet with those who do not have a disability, including shopping trips, attendance at clubs and visits to places of interest and entertainment. Staff were seen to interact appropriately with the residents and treated them with dignity and respect. The house routines were flexible to meet the needs of the residents with residents having unrestricted access to all areas of the building. Staff appeared to be well aware of where the residents wanted to be and what they wanted to do. All of the residents need full assistance with all personal care needs and as far as possible choice was given over what clothing to wear. Where choice was not possible staff ensured appropriate clothing was worn. Residents were unable to assist in any household tasks. Meal times were observed and were relaxed, with residents being encouraged to feed themselves. It is advised that assistance is sought from KAB to see if specialised eating aids would assist some of the residents. Again due to the level of disability none of the residents could assist in preparing meals or making informed choices over menus. Staff were aware of likes and dislikes and menus were arranged accordingly. All staff held a Basic Food Hygiene Certificate. Food intake was recorded to determine that nutritional needs were met and resident were weighed on a regular basis. Little evidence could be found of any written nutritional assessment in the care plans. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 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 standard(s) 18,19,20,21 Residents benefit from having clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Care plans are regularly updated to ensure changes are recorded and acted upon. Health needs are met and service users benefit from having full access to all professional health care services as required. Residents are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Staff were observed offering good support for personal care and encouragement was given where possible. All of the care plans indicated individual preferences about how the residents are to be supported with their personal care. The issue about bed times was again discussed and it remains an issue. The matter was discussed in full and the manager agreed to revisit the rotas to ensure residents were not left alone downstairs whilst other residents were being given assistance to go to bed. The manager stated that some of the residents do receive additional specialist support from physiotherapists and aromatherapists. Resident required full assistance with all medical and healthcare needs and evidence seen during the inspection confirmed that full support is offered as 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 15 required. On the day of the inspection one resident was clearly unwell and although the doctor had already visited twice a further visit was requested. It was clear that staff were very much aware of the physical discomfort of that resident and made every effort to ensure his needs were met. The home had developed a very good relationship with the local GP, which benefited all the residents. Regular visits from other professionals included physiotherapists, epilepsy nurses, district nurses, chiropody, dentist, reflexologist, opticians and Psychologists. The manager had completed a recognised course on the safe administration of medication and now monitored all staffs practise and tested their competencies on a regular basis. Evidence was seen of PRN protocols being in place that gave clear instructions to staff over the use of PRN medications. All staff were trained in the correct use of rectal diazepam. The medication administration was inspected and found to be following the guidelines from the Royal Pharmaceutical Society of Great Britain except for the collection of the prescription from the Pharmacist from the GP. The relevant guideline was discussed with the manager who stated that she would review the procedure and comply with the guidelines. MCCH had a policy on bereavement, which would be followed in the case of any death of a resident. The manager did explain that they would always endeavour to keep a resident who had a terminal illness, for as long as it was medically possible. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 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 standard(s) 22,23 The home has a clear and effective complaints system in place and residents are protected by robust adult protection policies and procedures. EVIDENCE: MCCH has a comprehensive complaints policy that was clear and if used correctly would be effective. A timescale for responding to complaints was included. There had been no complaints since MCCH had responsibility for the home. A basic policy was seen in pictorial form. The home had adopted Kent and Medway’s Adult Protection Policy and staff were familiar with the issues around adult abuse and were able to discuss the types of abuse in detail. Advice was given over the new POVA register. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 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 standard(s) 24,25,27,30 Residents benefit from living in a clean, safe environment and have safe access to indoor and outdoor communal areas. Not all of the areas are well maintained and some re-decoration and replacement of equipment and furniture is necessary. Whilst service users’ rooms are fairly homely and reasonably comfortable not all service users benefit from living in single rooms that meet the requirements for space. EVIDENCE: The general layout of the home could be described as homely but in need of some attention. The lounge area is in need of re-decoration, particularly as a gas fire had been removed and the wall had not been decorated. The furniture was discussed with the manager who agreed it was not appropriate or practical for the current residents. One resident had a specialised armchair but the remaining armchair and settee had material covers and a wooden frame. Bearing in mind the visual impairment of two of the residents the wooden frames were a hazard and should be replaced with more suitable ones. The 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 18 ramp to the garden had been removed and roughly made good. However this had left a large gap in the floor covering and this now needs to be replaced urgently. The cooker oven was also out of use and needs to be replaced urgently. Sensory lighting was seen in the lounge and one resident was seen taking great comfort from a box of personal items that were stored in the lounge. The one shared bedroom on the upper floor had no dividing curtain and it is doubtful whether the two resident have made an informed choice over sharing. The bedrooms generally are not well personalised or homely, however it is recognised that residents do not spend much time in their bedrooms. The bathroom on the upper floor would benefit from redecoration and the seal on the floor needs replacing. The manager stated that the chair hoist, although operational, is now obsolete and could not be repaired in the future. It is strongly advised that a replaced is purchased as soon as possible to prevent the home being without a chair hoist in the future. The home was clean and hygienic on the day of the inspection. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34,36 The residents’ benefit from being cared for by staff who have a good understanding of their needs and receive regular supervision. EVIDENCE: Staff spoken to during the inspection stated that the home was a relaxed place in which to work and were very sensitive to the residents needs. Staff files were bought to the home during the inspection and are now to be stored securely in the home. All staff had adequate job descriptions. The manager stated that she was now expecting to be more involved with the recruitment process in the future and that she had received training in recruitment and selection of staff. Staff supervision had started and the manager was advised to record individual sessions and keep in a confidential manner. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 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) No judgements made EVIDENCE: Not assessed at this inspection 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 21 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 1 3 2 3 1 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 x 2 x x 3 Standard No 11 12 13 14 15 16 17 3 2 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 x x x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 340 Wilson Avenue Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score x x x x x x x H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 22 N/A 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. Standard YA1 Regulation 4(1)(b) Requirement The Statement of Purpose and Service User Guide must be updated to provide correct information regarding the services offered and to include all the information indentified in the Care Home Regulations 2001 and the National Minimum Standards. The home must provide screening in the shared bedroom or provide clear reasons why this is not provided. The decorative state and furnishings in the lounge must be reviewed and action taken as required. The kitchen floor needs to be replaced The cooker needs to be repaired or replaced with a new one. The bath chair/hoist should be reviewed and replaced before it fails completely Timescale for action Action plan by 1st August 2005 2. YA 25 16(2) 3. YA28 23(2)(d) 4. YA 24 23(2)(b) 5. YA24 23(2) 6. YA24 23(2) Action plan by 1st August 2005 Action plan by 1st August 2005 Action plan by 1st August 2005 Action plan by 1st August 2005 Action plan by 1st August 2005 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 23 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. Refer to Standard YA6 YA 20 Good Practice Recommendations It is recommended that further information from specialist providers be sought to enhance the lives of residents who are registered blind. It is recommended that prescriptions should be collected from the GP by the manager/designated person to check them againsts items ordered before they are submitted to the Pharmacist. 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent. ME16 9NT 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 340 Wilson Avenue H56-H06 S64405 340 Wilson Ave V229391 200605 Stage 4.doc Version 1.40 Page 25 - 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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