Inspection on 24/05/05 for 56-58 Turnbull Close

This inspection was carried out on 24th May 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

56-58 Turnbull Close 14/06/07

56-58 Turnbull Close 10/05/06

56-58 Turnbull Close 03/11/05

56-58 Turnbull Close 20/12/04

56-58 Turnbull Close 13/07/04

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

CARE HOME ADULTS 18-65 56/58 Turnbull Close 56/58 Turnbull Close Greenhithe Kent DA9 9EB Lead Inspector Eamonn Kelly 24 /25 th th Unannounced May 2005 at 03.00 pm 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. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Walsingham, 56/58 Turnbull Close Address 56/58 Turnbull Close Greenhithe Kent DA9 9EB 01322 381568 01322 381852 turnbullclose@walsingham.com Walsingham 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) Mr John Henderson Care Home 12 Category(ies) of Learning disability (12) registration, with number of places 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20 December 2004 Brief Description of the Service: 56/58 Turnbull Close residential home (part of Walsingham which has some thirty-four homes in the group across the UK) provides care and accommodation for up to twelve people with physical and learning disabilities. The premises were purpose built. Accommodation is divided into two units, each with its own communal areas. All service users have single bedrooms that are individually furnished and equipped with significant support from relatives and supporters. Some service users have “motability” vehicles. Other organisations (e.g. Yew Tree Centre and Social Education Centres) supplement the homes’ own transport provision in enabling service users to attend specialist day centres. The premises have safe landscaped gardens used by service users. Twenty-four hour care is provided (at night there are two support workers on duty, one sleeping and one awake). A registered manager, currently undertaking the Registered Manager’s Award, runs the home with assistance from a Walsingham support network. The home is within easy reach (by car) of a range of local amenities and public transport. There are good parking facilities. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An inspection visit was made on 24 May 2005 during which a number of service users and members of staff were met and some of the home’s facilities and services were seen. On the following day, visits were made to 2 day-care institutions where 11 service users were met and their activities observed. The CSCI pharmacy inspector made a visit to review issues raised by the manager and a separate report following this visit was sent to the home. What the service does well: What has improved since the last inspection? What they could do better: There is a need for appropriate pre-admission documents (ie. service user guide/statement of purpose) to enable prospective service users and their supporters to assess the home’s facilities and services. Each service user (or their principal advocate) should have a personal contract that states clearly 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 6 their rights and responsibilities and those of the home, including individual terms and conditions of residence and care provision. 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. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 5 Prospective service users and their supporters do not have the information they need to make informed choices at admission stage. In addition, the absence of a proper contract that clearly states service users and the home’s rights and responsibilities contributes to possible misunderstandings about the home’s ability to provide suitable services. EVIDENCE: Whilst an effort has been made to produce a service user’s guide/statement of purpose, the resulting documents are not available as a properly produced package. In addition, some of the information contained in the drafts is misleading. There is an “agreement” available to service users: this is produced in “easy words and pictures” but it does not serve as a personal contract that clearly states the rights and responsibilities of both parties. These shortfalls have produced the effect that service users with nursing care requirements may have been admitted without the appropriate levels of staffing attention. Also, there are a number of rules which have not been adequately described by the home in its pre-admission and post-admission documents [eg. where welfare benefits are used collectively by Walsingham: although the CSCI provider relationship manager is negotiating a corporate approach on these issues, the issue (as an example) must be covered in a comprehensive personal contract). Nevertheless, in the examples discussed, there is a comprehensive assessment made of potential service user’s care needs with social services advice and guidance in each case. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 9 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 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 and 9 Service users receive good support and supervision from members of staff based on assessed and recorded care needs and identified goals. EVIDENCE: Following initial assessment to determine the suitability of the home for a potential service user, an individual written service user plan is begun. This is added to as on-going reviews of service user’s needs require (and particularly each six months after major reviews involving care managers and others). [Copies of skills training records for each service user were inspected as were some copies of service user’s “life books”]. Service users live within a fairly rigid framework as a set of activities during weekdays between 09.00 am and 04.00 pm has been determined for them [ie. they are transported to either of 2 day centres (2/3 use Gravesend SEC and 9/10 use Dartford Yew Tree centre)]. A member of staff is always at the home, however, in case a service user has to return home. Some service users visit their family homes and stay there for agreed periods of time. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 11 There was evidence that service users have opportunities to participate in the day-to-day running of the home insofar as their level of disabilities permit. Members of staff were receiving advanced training on the 2nd day of the inspection on how to communicate with service users with little apparent communication skills. There was evidence that these skills prompt and help service users to enable staff to understand their needs. There were examples of how members of staff help service users to take responsible risks (eg by taking part in activities outside and within the home and by moving about the premises with help as needed). The capabilities and potential of service users are recorded in care plan records and “life books”. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 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 and 16 Service users have good opportunities for personal support and development and access to appropriate leisure activities within and outside the home. These opportunities and activities are enabled by access to 3 vehicles and additional transport provided by the 2 main day centres working with the home. EVIDENCE: 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 13 There was evidence that members of staff understood the personalities and assessed care needs of each service user that helped each to achieve a good quality of life. The home has the use of three vehicles for transport; a minibus which can accommodate two wheelchair users, a car which can accommodate one wheelchair user and a smaller car. The 2 main day centres co-operating with the home (Yew Tree and Gravesend SEC) also pick up and return service users each weekday. Members of staff also arrange a variety of outings for service users (eg. local Thames ferry trips, escorted trips within the UK and abroad, smaller group outings by car). A service user has a “Motability” vehicle funded from personal mobility allowance. A member of staff is in control of the vehicle (on behalf of the service user) during the week and the service user’s family has responsibility for it at weekends. The manager previously stated that specific arrangements such as this would be incorporated into revised individual personal contracts, but this has not yet been achieved. A record book accompanies service users going to the Yew Tree Centre and Gravesend SEC to record the types of leisure activities or living/educational skills experienced that day. In principle this assists members of staff to assess how each service user progressed during the day outside the home. During the visits to 2 day-centres during the inspection, it was clear that service users had a variety of activities (including activities and learning opportunities outside the day centre) to suit their capabilities and potential. In one case, a service user’s key worker at a day-centre described how important it was for service users to have a key worker because of the need for continuity in support. The lack of an effective key worker system within the home (due largely to staff turnover and dependence on agency staff) contrasted with this positive measure. Examples of leisure opportunities outside and within the premises were discussed. An annual holiday is also provided for which each service user receives a non-returnable grant of £500 from WALSINGHAM. Members of staff support service users to maintain family links and friendships inside and outside the home: there was evidence of extensive contact between service users and members of their families. The daily routines and house rules generally serve to promote variable measures of independence, individual choice and freedom of movement: restrictions agreed and risk assessments are included in care plan records. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 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 & 20 Service users have good access to all medical services: their healthcare needs are kept under review and support needs and healthcare provision is recorded (the CSCI pharmacy inspector made recommendations to improve the administration of medication). EVIDENCE: All service users require a high level of personal care. There is a variety of disability aids and equipment available. Service users have access to their GP (seven GPs have patients at the home). Each service user has an allocated care manager. KAB (Kent Association for the Blind) and a Dartford optician provide services on request. Community practice nurse, district nurse, physiotherapy, occupational therapy, dietician, and speech therapy services are provided. Medication is securely stored and administration of medication is closely supervised. Aspects of this provision have been assessed in some detail by the service manager (as recorded in monthly regulation 26 reports submitted to the CSCI). Issues relating to medication storage at the home were raised by the manager during the inspection visit. The CSCI pharmacy inspector subsequently made a visit and some recommendations were made [ie. use of a digital thermometer to check temperatures at which medications are stored, liaison with the 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 15 supplying pharmacist to ensure that medication dispensed is labelled with proper directions for administration and that the home has guidelines for the administration of “when required” medication to ensure consistent administration]. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 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) x These standards were not assessed on this occasion. EVIDENCE: 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 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, 26, 27, 28, 29 & 30. The home provides excellent accommodation for service users and there is a wide range of specialist equipment for the safe and efficient care of people with significant physical dependency needs. EVIDENCE: 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 18 Each service user has his/her own bedroom. All rooms have been furnished in a different way, sometimes with direct support from service user’s family. Service users have the use of surrounding landscaped gardens that have been recently equipped with additional garden furniture. Some bedrooms are equipped with ceiling track hoists. Previously, a member of staff demonstrated the operation of these and outlined the “moving & handling” training provided for all staff. A service user has a special bed that descends to floor level to enable the service user to transfer independently to the floor. Currently there are no service users who could benefit from the personal use of bedroom door keys. The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. There are excellent toilet and bathroom facilities. There is a separate kitchen, dining and lounge areas for each group of 6 residents. A visitors room is also available to service users and their visitors. The home was purpose built for the care and accommodation of people with learning and physical disabilities. It is suitable for use by wheelchair users. Disability aids include a call bell system (operational but unused by service users because of their high dependency needs), four ceiling track hoists (in bedrooms and bathrooms), a battery powered hoist, Parker baths, two shower beds, three specialist reclining chairs and a toilet chair (and a device for helping to handle people who have fallen, but which is now rarely used because of the introduction of alternative safe movement methods). The home also has two vehicles that accommodate wheelchair users. The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the home’s stated purpose and the individually assessed needs of all service users. The premises were clean and hygienic. There is a well-equipped laundry room. There are a small number of refurbishments that need to be progressed for the continuing good care and convenience of service users (ie. redecoration of some common areas, provision of wider doors in 2 instances for the benefit of service users). 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 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) 34 Whilst efforts are made to have an adequate number of staff in place, the home’s recruitment practice is not under the full control of the manager. This may have a detrimental effect on service users (eg. difficulty in maintaining a key worker system). EVIDENCE: Some service users have a level of care that may be equivalent to nursing care (the condition of one service user required virtually constant staff attention). The minimum staffing levels comprised 2 2 support workers for service users with another “floating” between the two sections of the premises. The reasoning is that this member of staff would, for example, be additionally available to assist with hoisting operations that always needed 2 members of staff. The staff group were mainly agency staff. The manager is not in full control of the home’s recruitment procedures and this problem is likely to contribute to the difficulties of the home in recruiting and retaining permanent staff. Recruitment procedures are dominated by requirements involving Walsingham’s London office. The manager provided information about the general Walsingham process of recruitment. (Since the inspection visit, 2 new members of staff have started work, another is due to start and 5 further 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 20 potential members of staff are at CRB-checking stages of their applications. A further recruitment campaign is planned). In the 2 cases checked during the inspection, the recruitment process takes in excess of 3 months and potential support workers are likely to have become employed elsewhere during this extended period. The detriment to service users is that there is no established staff group that, for example, provides an effective key worker system. The potential effectiveness of such a system was demonstrated at a day centre where a particularly good service was being provided to one of the home’s residents within a key worker framework. During the inspection, members of staff on duty were caring well for service users in their care. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38 and 42 Service users benefit from the experience of the management team and the good management approach of the home. This approach is facilitated by clear guidelines for continuous improvement identified during monthly visits and reports prepared under Regulation 26 [by the service manager]. EVIDENCE: 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 22 The manager is undertaking the Registered Manager’s Award. The deputy manager is completing NVQ Level 3 in Promoting Independence and the NVQ Assessors Award. The manager has extensive experience in the care of people with learning and physical disabilities. The deputy manager previously worked at the home as a support worker and is included on the staffing roster (as is the manager who also works “sleep-in” shifts). The service manager submits excellent monthly reports (under regulation 26) to the CSCI. These cover every aspect of policy and procedures for the safe and effective care of the home’s residents. The reports are a good framework for the management of the home and there is no doubt that service users benefit from a well run home. Members of staff met on this occasion had a good knowledge of the care needs of service users. As service users returned from their day at 2 day-centres, there was evidence that they were able to each acclimatise to the home environment in different ways with sufficient support. The home is maintained as a safe place for service users with staff on duty at all times including when all service users are at external locations. The risks associated with the supervision of each service user are recorded and maintained as part of service user care plans. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 2 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 4 3 3 4 3 3 x Standard No 31 32 33 34 35 36 Score x x x 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 56/58 Turnbull Close Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 3 x H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 24 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. Standard 1 Regulation 4&5 Requirement There must be adequate and suitable pre-admission information available for potential service users and their supporters to enable them to make judgements about services and facilities at the home. The information referred to in the above requirement must be readily available in a well prepared information pack. A copy must be provided to all service users (in the case of service users at this home, the copy should be provided to their main supporter). Each new service user (or their main supporter) must be supplied with a personal contract that clearly states their rights and responsibilities as well as those of the home. Timescale for action 01/08/05 2. 1 4&5 01/08/05 3. 5 17 01/08/05 4. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 25 No. 1. 2. Refer to Standard 24 20 Good Practice Recommendations The planned refurbishments should be implemented as soon as possible. It is acknowledged that the manager requested advice on specific medication administration matters and that he has implemented the recommendations made by the CSCI pharmacy inspector. 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 26 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 56/58 Turnbull Close H56-H06 S23873 56-58 Turnbull Close V227856 240505 Stage 4.doc Version 1.30 Page 27 - 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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