Inspection on 31/07/06 for 52 Russell Terrace

This inspection was carried out on 31st July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

52 Russell Terrace 10/09/07

52 Russell Terrace 25/10/05

52 Russell Terrace 07/06/05

52 Russell Terrace 15/02/05

52 Russell Terrace 10/08/04

52 Russell Terrace 19/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 52 Russell Terrace 52 Russell Terrace Leamington Spa Warwickshire CV31 1HE Lead Inspector Martin Brown Key Unannounced Inspection 31st July 2006 10:45a 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 52 Russell Terrace Address 52 Russell Terrace Leamington Spa Warwickshire CV31 1HE 01926 431471 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Turning Point Miss Tracey Bates Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (4) of places 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age Range of Service Users People admitted to the home must be in the age range of 18 to 64 years. 25th October 2005 Date of last inspection Brief Description of the Service: The home is registered for six adults with learning disabilities. It offers a service to people with complex needs and communication difficulties. At present, there are four older people with learning disabilities and some agerelated difficulties, and two residents with profound learning disabilities and high communication needs. Turning Point operates the home; it is a national organisation that provides services to primarily to people with drug and alcohol problems, but also with learning disabilities. The home is a converted Georgian house, which has been extended to provide additional kitchen and bedroom space. Accommodation is on two floors. There is a bathroom on each and a separate WC on the mezzanine level. The ground floor has been adapted to provide level access to, and within, the home for wheelchair users. There are two bedrooms on the ground floor in addition to the lounge and dining/ kitchen area. There is a laundry/conservatory area at the rear of the house. There is a large flat garden that includes a swing, suitable furniture and a sensory area. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been made using evidence that has been accumulated by the Commission for Social Care Inspection. This includes information provided by the home, in the form of a comprehensively filled out pre-inspection questionnaire, and detailed regulation 26 visit records. Feedback cards for service users and relatives were sent to the home but none were received back. I was advised by staff on the day of the inspection that service user comment cards had been filled in, and, as far as they were aware, returned. The inspection visit was unannounced and took place on 31st July 2006, between 10.45am and 3.15pm. All service users were seen over the course of the inspection, as were staff on both the morning and afternoon shifts. A tour of the premises was made, relevant documentation was looked at, and observations of the interactions between residents, staff and their environment were made. Despite communication difficulties, service users were able, where they wished, to express views, either verbally or non-verbally. Staff were helpful throughout. The manager was not present, but the thoroughly completed pre-inspection questionnaire, in addition to clearly laid-out policies and guidance, greatly assisted the inspection. What the service does well: What has improved since the last inspection? Staffing ratios have improved, in order to meet the increasing age-related needs of service users. This was evident in the variety of individual activities that take place. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 6 A noticeable improvement in the well-being of one younger resident was noted, following a small change in medication. She is now enjoying a wide range of activities and seemed far more settled than previously The downstairs toilet and bathing facilities are now much improved, as is the front downstairs bedroom. Fire precautions are much improved. 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. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area has been found to be good on previous inspections and, although not fully assessed on this occasion, there are no grounds for believing a judgement to be any different now. EVIDENCE: There have been no new admissions to the home for over twelve months. The standards in this outcome group were satisfactory when previously assessed. Evidence of satisfactory initial assessments of current residents are still in place in individual files. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Residents benefit from clear guidelines and knowledgeable staff to support them in making decisions and take risks. This enhances their individual development and general well-being. EVIDENCE: Individual care plans were sampled, and showed how needs were assessed and met. Life histories, well illustrated by photographs and ‘souvenirs’ such as tickets, programmes of events, were seen. One staff queried the value of these being kept in such detail, as the resident concerned now had three such large folders. She agreed to raise the matter at the next staff meeting, on the premise that such folders should be maintained not for their own sake, but only if they serve a useful purpose for the resident or for significant others. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 10 Staff were able to talk knowledgably about individual needs, relating behaviours, needs, and wishes to guidelines, and to individual development. Decision-making was seen in respect of individual activities chosen by residents. Some residents are able to make their wishes known more readily than others. When one resident made her displeasure known, one staff member was able to quickly work out what the problem was, and rectify it. Staff were able to explain work being done with ‘objects of reference’ such as bubble bath bottles, to help one person make decisions and have them understood. Specific areas of risks were managed in accordance with clear easy-to-read guidance notes, well illustrated with photos. Staff agreed that these were far more useful in the managing of individual risks than the standard risk assessments provided by Turning Point, which tended to be more generic, and organisation-focused, rather than user-focused. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Residents are supported in a variety of individual activities that they enjoy and look forward to, and in which their rights and responsibilities are recognised and respected. They enjoy a healthy diet in convivial surroundings. EVIDENCE: All the residents have ‘active support plans’, which detail a timetable of events for the week, tailored to that person’s needs and wishes. Individual activities took place throughout the day. These were generally small-scale, one-to-one activities, which residents were seen to look forward to and enjoy, such as going to the local shops for particular items, and having some personal beauty care. Photographic records showed recent activities such as a canal trip, and a visit to a local fete, being enjoyed by residents and staff. Holidays take place in accordance with individual wishes, with staff informing me that some residents preferred shorter breaks, or day trips, whilst longer holidays were planned with other residents. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 12 One resident is supported to retain contact with a friend from a previous home; she was eager to tell me that he was coming for tea that week. One resident is visited by a former advocate who has retained contact after funding ended; other residents have family contacts. Photographs of residents, staff, friends, and relatives are much in evidence, but not overwhelmingly so. Menus and a well-stocked kitchen showed a variety of food on offer, with provision being made for special diets. Residents were seen to enjoy lunch together, in a friendly, leisurely atmosphere, with choices being offered and respected. A picture menu board assists residents in making and understanding choices. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 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 the following standard(s): 18,19,20 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Residents are able to receive support in ways that enhance their well-being, independence, and quality of life. The age-related needs of residents would be better served if the stairs were supplemented by a lift. EVIDENCE: There have been a number of falls recorded in previous months. These involved older residents at the home, occurred in different areas of the home, and happened when staff were not in the immediate vicinity. The service has responded to this by increasing staffing, and ensuring, in one instance, that a resident does not use the stairs without staff accompaniment and guidance. The incidence of falls has reduced markedly since these changes were introduced. Two residents have downstairs rooms. Staff said that they understood that a lift was still being sought so that the other resident seen as at risk of falling does not have to use the stairs. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 14 Two residents, both of whom have had falls, were observed washing up and tidying up. Staff said that they valued their independence, and discussion with them, as well as observation, showed this to be so. One resident was noted to be far more at ease than was the case at the previous inspection. Staff commented that the introduction of new medication had reduced agitation, helped her sleep, and enabled her to enjoy activities such as shopping. Staff were clearly very pleased with the improvement in her quality of life and were keen to help her continue this. Details of the night routine were seen, including recordings of regular checks, signed by staff. Medication records were seen to be satisfactory, with clear guidelines on administration and individual preferences, individual photographs of residents, and signatures of staff able to administer medication. Although the member of staff showing me the medication procedures was able to talk knowledgeably on most of the medications, she agreed that it might be useful for staff to have, included in guidelines, a brief guide to each medication, the reason for its use, and any potential issues associated with its use. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 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 the following standard(s): 22,23 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The open, friendly atmosphere evident throughout the home, combined with a clear lead from management in the form of policies and their implementation gave a confidence that residents’ views are listened to and acted upon, and that their best interests are protected. EVIDENCE: Staff were aware of vulnerable adult issues; throughout, resident and staff interaction demonstrated an atmosphere of respect, where views were heeded and choices supported. This was evident in how well residents interacted with each other, and were tolerant of each others differing needs and wishes. Residents were largely free to do as they wished, and staff were on hand to provide support and encouragement where needed. Good clear financial records, along with clear guidance for staff in supporting individual residents where appropriate, were seen. Appropriation action was seen to be taken by the organisation in respect of allegations made against the service, and appropriate policies and procedures are in place, and followed. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 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 the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The home is well furnished, although some repairs and improvements to the outside of the building are still required. The long-term interests of the older residents require the installation of an alternative to using the stairs. EVIDENCE: The home continues to be homely and comfortable. The lounge in particular is well furnished, and tastefully decorated, including works of art the residents helped to create. The downstairs bedroom has been refurbished, as has the downstairs toilet and bathroom, which is now a shower room. Staff informed me that the roof had leaked during heavy rain the previous week and is consequently to be replaced. Evidence of the leak was still visible. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 17 The home has no stairlift or lift. Two residents now use facilities exclusively downstairs. One resident uses the stairs only when escorted by staff. Staff advised that the service is still negotiating to have a suitable lift installed, a matter that is becoming increasingly urgent as two of the residents using upstairs rooms continue to age. Two younger residents have only way to access upstairs is by the stairs, which is becoming increasingly difficult. Bedrooms are spacious, and furnished and decorated according to individual wishes; residents spent time in them during the day, either listening to music, or just relaxing. The conservatory area continues to be a popular area for residents to sit. One resident sat there keeping a watch on her laundry in the washing machine. The paint on the outside of the windows of the conservatory are badly flaked. A light outside the conservatory had come loose in the recent stormy weather. The garden continues to be used by residents, either just for sitting in or eating at the outside table, or, in the case of younger residents, using the swing or the hammock. The garden is large enough to accommodate the differing needs and wishes of residents. The front gate and front downstairs bedroom window frame contain rotting wood and are in need of attention. Staff advised that in respect of other areas, notably the front door and the outside rendering of the building, where refurbishment is overdue, the manager has been in contact with the landlord’s representative in order to effect these. The kitchen continues to be clean, well stocked, hygienic and well maintained. The home was clean throughout and free from unpleasant odours during this unannounced inspection. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Residents benefit from the attentions of a sufficient number of suitably trained staff who are familiar with them and with whom they are comfortable. EVIDENCE: As the manager was not present, staff files could not be looked at. At the previous inspection, these were examined and were seen to be satisfactory, other than a minor shortfall in procedures that had since been rectified. Information provided by the manager to accompany the pre-inspection questionnaire, along with previous information provided on regulation 26’s, showed appropriate staffing, recruitment procedures, and training. There are pictures of the staff in the hallway, and pictures in the kitchen area of ‘today’s staff’ to help residents be clear who is available. One staff member on duty is currently ‘project worker 2’, a role that she explained is effectively deputy manager. It was a previous requirement that there be a deputy manager as the manager was also undertaking a wider role within the organisation. I was advised by this staff member that the manager is to return to the sole position of manager of the home. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 19 There were three staff on duty every shift; this is now necessary because of the increased needs of a number of the residents, and enables more flexibility and a greater ability to meet individual needs satisfactorily. Some agency workers are used; there were two on duty during the two shifts on the day of the inspection. Both were familiar with the residents and their needs, and one was soon to become a permanent member of staff. This member of staff showed herself very knowledgeable of the needs and wishes of the person she had been supporting, and was looking forward to taking advantage of the training opportunities provided by the organisation. Permanent staff were able to discuss the benefits training received, particularly dementia training, which was a previous requirement. The staff on duty acknowledged that there has been no training in falls prevention training. One agency worker praised the home for the thoroughness of its induction process and compared it extremely favourably to other homes she had worked in. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Clear leadership and procedures ensures the home continues to be safe and well run in the best interests of the residents, even in the manager’s temporary absence. EVIDENCE: The manager was not available for this inspection. Such was the clarity of laidout procedures and guidelines, and the confidence of staff in being able to follow these, that the home was functioning very effectively in her absence. The pre-inspection questionnaire returned by the manager detailed appropriate checks and measures for maintaining key areas of safety in the home, such as fire safety, electrical, gas and water checks. No hazards were noted in the home, other than the number of falls noted, which are being managed as previously noted in the report. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 21 Regular and thorough regulation 26 visits take place, records of which highlight the strengths of the service, as well as areas in which it needs to improve. Residents’ meetings and relative forums take place, but staff advised that feedback from both residents and relatives often takes place directly, on an individual basis. In some cases, residents are able to raise issues and discuss matters such as what activities they would like to take part in, in other cases, the home provides activities, and gauges how particular residents, who find it difficult to communicate their wishes, enjoy them. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 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 YA24 YA24 Regulation 16(1) 16(1) Requirement The light outside the conservatory must be made secure. The front of the house, most notably a rotting window frame and a rotting gate, requires attention.(This is outstanding from the previous inspection) A plan to ensure the long term safety of residents using both floors in the home must be provided, detailing what alternative to using the stairs is to be provided. Timescale for action 28/08/06 28/10/06 3. YA29 23 28/11/06 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 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. 3. Refer to Standard YA20 YA35 Good Practice Recommendations It is recommended that the medication folder includes a brief guide to individual medications. Falls prevention training is recommended for all staff. 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 52 Russell Terrace DS0000058003.V305386.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!