Inspection on 01/02/06 for 74 Sir Evelyn Road

This inspection was carried out on 1st February 2006.

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

Other inspections for this house

74 Sir Evelyn Road 22/02/08

74 Sir Evelyn Road 01/11/06

74 Sir Evelyn Road 28/09/05

74 Sir Evelyn Road 24/03/05

74 Sir Evelyn Road 12/05/04

74 Sir Evelyn Road 03/12/03

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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 74 Sir Evelyn Road 74 Sir Evelyn Road Rochester Kent ME1 3LZ Lead Inspector Anne Butts Unannounced Inspection 1st February 2006 09:00 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 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 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 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. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 74 Sir Evelyn Road Address 74 Sir Evelyn Road Rochester Kent ME1 3LZ 01225 444 596 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) The Robinia Care Group Ltd Mrs Helen Elsie How Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two residents under the age of 18: (1) 6/4/1985 (2) 13/11/1985 Date of last inspection Brief Description of the Service: Sir Evelyn Road provides a specialist service for young adults with Autistic Spectrum Disorder. The home is registered to offer residential care for a maximum of six service users. The home is situated in a quiet residential area near to Rochester Town Centre, and has easy access to the local bus route. The home also has its own transport which is used for the benefit of the service users. The accommodation comprises of a large communal lounge/dining area, dining room, spacious kitchen, laundry room, toilets, bathroom, office. It has six bedrooms (four of which are en-suite). There is a large private garden that can be accessed from either the dining area or a separate door. The home offers high levels of staffing so as to enable 1:1 support to service users so that they have access to community, leisure and educational amenities. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the morning of 1st February 2006 – this entails the inspector arriving with no prior warning and is part of the methodology when inspecting homes that are registered with the Commission for Social Care Inspection. This home provides support to people with Autistic Spectrum Disorder and there is a high level of support needed for all service users within the home. On arriving it was immediately observed that the environment was well cared for and the service users who were in the home at the time were being well supported by the staff. Safety is a priority and identification, prior to being allowed into the premises, was requested alongside signing in and out of the premises – which is seen as good practice so as to promote both service user safety and in line with fire regulations. The manager was supportive during the inspection process and service users were free to participate where appropriate and where they wanted to be involved. There had been three good practice recommendations made from the previous inspection – and all of these had either been dealt with and one is incorporated as part of the ongoing maintenance programme. What the service does well: Service users are protected by the support and guidance provided by the manager and staff – and they in turn are supported by the larger organisations policies, procedures and ongoing commitment to the service users. Service users are also supported through assessments that ensure that their ongoing and changing needs are met. Care plans and risk assessments are individual and person centred – and service users can be confident that their needs will be met. Healthcare needs are fully met and supported by both the home and the larger organisation. Recruitment practices are good, and there is a thorough induction process in place, which is supported by a training programme. Staff demonstrated a commitment to meeting the needs of the individual and the atmosphere within the home was positive. The manager continues to demonstrate a good working relationship with both service users and staff and observation demonstrated that the service users were able to approach her and other members of staff, with no reservations. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 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 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 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, 4 and 5 Prospective service users are protected by an assessment process and transitional period that ensures their needs can be fully met. Service Users are protected by having their own individual contract. EVIDENCE: At the previous inspection it was identified that there is a full and through assessment process which ensure that they can meet individual needs and the home and the larger organisation continue to be committed to ensuring that this will be a suitable placement for the individual and ongoing and changing needs are closely monitored. The needs of this service user group are highly complex and they are very dependent on continuity of care. When they have been assessed for the home there is a structured planned transitional period that enables a full and supported settling period – so that the home can ensure that they can meet the needs of the individual. There are contracts in place and the home also actively supports service users with providing information in an appropriate format. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 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, and 9 Service users benefit from having clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Staff support service users in making decisions and act upon the choices that are made. Comprehensive risk assessments protect and promote service users in leading a fulfilling lifestyle. EVIDENCE: Care plans are set out in a structured format, and all are individualized and are set out in a person centred format. The care plans are built up with input from the service users. They are very focussed upon behavioural patterns and how staff can support and encourage service users in their daily lives. They detail likes and dislikes and are closely linked to ongoing reviews. Service users are encouraged as far as possible to make decisions with regards to their daily living activities and they are consulted with regards to going out, mealtimes, what they wish to wear and general daytime activities within the home. The home supports service users with their personal finances and 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 10 records are kept to ensure that their money is safeguarded. The dependency needs of this service user group are high and constant supervision is needed – the individuals’ best interests are at the heart of the care plans and they are reflective of how to ensure that their choices are promoted and any limitations in lifestyles are supported by appropriate assessments. There are extensive risk assessments in place and these are an integral part of the care plans. The risk assessments are used to support service users in maintaining a fulfilling lifestyle as possible and they encompass daily living routines and accessing activities. Staff are involved in the risk assessment process. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 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): These standards were not inspected on this occasion as they were met at the on the previous visit. However, during the course of the visit, observation showed that service users were supported in their choices of daily routines or activities. EVIDENCE: 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 12 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 and 21 Health needs are met and service users have full access to all professional health care services as required. The service users’ welfare is largely protected by the home’s policy and procedures with regard to the handling and administration of medication; however, an improved monitoring system would further protect service users safety. Service users and their families can be confident that their wishes with regards to ill health and end of life issues are handled with respect and sensitivity. EVIDENCE: The service users within the home are very dependent for all their needs on the staff within the home. This is either through ‘hands on’ care and support or through guidance and monitoring. The routines within the home are flexible to meet individual changing and ongoing needs and care plans reflect how staff should meet these needs. They are reflective of both behavioural and personal needs and observation on the day reflected that service users are supported in a manner that suits their needs. Times of getting up and going to bed are flexible as were mealtimes. Staff are trained in appropriate communication methods including Makaton and demonstrated a good understanding of their needs. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 13 Healthcare needs are met through the homes ongoing monitoring systems, and there is regular input from specialist healthcare professionals relevant to the care and support of the individual. Records showed input from the dietician, community psychiatric nurse, G.P., dentist and epilepsy nurse amongst others. There are regular reviews taking place in order to support service users healthcare needs. Medication was inspected and it is reasonably well managed – however there are some shortfalls that need to be addressed. It was identified that there is a need for a regular auditing and monitoring system to be put into place and a requirement is being made to this effect and this should include a system for checking the competency of staff who regularly administer medication – and this is due to the awareness being raised more and more with regards to the administration and monitoring of medication - following on from this any other shortfalls will be monitored and addressed. There are some good practice systems that should be considered and put into place and recommendations are being made with regards to this. It should also be recognised, though, that medication is kept in a secure location and all staff that administer have received training in this area. There are records showing medication in and out of the home are monitored and there are policies and procedures in place, including a homely remedies policy. Issues regarding ill health, aging and death are treated in a sensitive and appropriate manner – taking into consideration the young age of the service users within the home – families are fully consulted with on all the needs of the service users. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 14 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 and 23 Complaints and adult protection procedures within the home serve to safeguard service users, however in order to further protect service users all staff need to be trained in Adult Protection procedures. EVIDENCE: There are no recorded complaints and any issues are monitored through a thorough Regulation 26 visit – which consists of a senior member of the organisation visiting the home and carrying out an internal inspection. The results of these are forwarded to The Commission for Social Care Inspection on a regular basis. Records and evidence showed that the home and larger organisation are committed to ensuring that the best interests of the service users are safeguarded and that there is an open and transparent process for monitoring this. There are adult protection polices and procedures in place and the home was able to evidence that service users personal monies are safeguarded and any transactions are fully recorded. Staff are not employed prior to appropriate checks being carried out – however not all staff have been trained in adult protection procedures and although they have been allocated a place in the yearly training programme – the home must ensure that this is a priority training need – alongside any other mandatory training needs identified within their training and development programme and a recommendation is being made to this effect. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 15 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 Service users benefit from living in an environment that is largely well maintained, and reflects their choices and lifestyle. EVIDENCE: A full tour and inspection of the environment was undertaken at the last visit and the standards were all met. It should be noted that overall the home is comfortable and homely – although it is fairly sparsely furnished but this is in keeping with the needs of the service users. The main living area is decorated with artwork and paintings, which have been prepared by the service users. The kitchen is still in need of some refurbishment – but this is scheduled into the ongoing maintenance and decoration programme and is being addressed. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 16 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): 31, 32, 33, 34, 35 and 36 Service users can be confident that a competent and qualified staff team meets their needs. However, their care could be compromised where staff are not fully up to date with mandatory training needs. Service users are protected by a thorough and robust recruitment procedure. EVIDENCE: At the previous inspection it was identified that the home ensures that staff are fully aware and supported in the role that is required of them in order to support and meet the needs of the service users within the home – this has not changed and the home has continued to ensure that staff are fully supported in their role within the home. Staff are made aware of which are essential and desirable skills for working with this service user group and are issued with a job description. There are key workers in place for service users and it was observed that the service users have a trust and respect for the staff within the home. Individual care plans set out as to how staff supports the service users. Some staff have obtained an NVQ and others are in the process of enrolling onto NVQ programmes. Staff are also supported in getting to know the specific needs of the service users. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 17 There are ten members of staff supporting service users – which allows for the 1:1 support needed. There have been 2 new members of staff employed recently and also an additional member of staff to support via ‘bank duty’. A thorough induction process supports staff in their new role and this also includes ‘Bank Staff’. Agency staff are only used on very rare occasions and this will usually be a regular person. The induction process is structured and is supplemented by training. Staff are also supplied with information leaflets on key areas such as COSHH and behaviour management guidelines. The induction is signed at appropriate intervals so as to evidence staff have completed this training. One member of staff stated “This is the best company I have worked for – the training is brilliant – they will try to get you what you ask for – and I really enjoy going out and about with the service users”. As part of the induction process new members of staff work alongside senior members in a shadowing role – prior to being incorporated into the duty rota. The manager has recently carried out an audit of the training needs of the staff within the home and has identified where training is needed. There are some shortfalls in some areas, and staff are being booked onto the relevant courses over the up and coming months – as stated with regards to Adult Protection training the home must ensure that those staff who are most in need of mandatory training must be treated as a priority so as to ensure continuity of care. The organisation offers a wide range of mandatory and service specific training and if staff identify further courses, which they feel will support them in their role – these may also be accessed. Staff supervision does occur, but not on a regular basis – however the manager did state that there is a lot of informal supervision with staff and two members of confirmed this and stated “I am very supported by the manager – she is always there to talk to me if I need her” and “I am well supported by the manager and also the other staff who work here”. The planning of formal supervision is in place for the coming year and it is recommended that as far as is practicably possible the manager ensures that the timetable is maintained. Meetings are held, where possible - due to the needs of the service users it is not always possible to have all members of staff together – however the manager tries to ensure that the information is cascaded through the home by having team leader meetings. It was recommended that staff should read and sign that they agree the minutes / outcomes of meetings. There are robust recruitment policies and procedures in place, and prospective staff members work a ‘shift’ prior to being offered a position – supported by an appropriate senior staff member. References are obtained and all appropriate POVA and CRB checks obtained. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 18 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 19 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, 38 and 42 Service users benefit from a manager who is clearly committed to safeguarding and promoting individuals independence, rights and choices and is assisted by a stable staff team who offer a good quality of support to the service users. Service users health and safety is protected by systems in place to ensure their health, safety and welfare. EVIDENCE: There is an experienced and competent manager in place whose day-to-day responsibilities include the running and organisation of the home and ensuring that that service meets the needs of the service users. Direct observation showed good rapport with staff and service users and it was evident that good working relationships are in place. She is continuing to update her own skills through ongoing learning. She also stated that the larger organisation are supportive and committed to meeting the needs of those living within the home. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 20 She manages the home in an open and transparent manner and staff and service users were seen to be able to approach the manager with any issues or requests. Her approach to supporting staff and service users was seen to be positive and pro-active. Records showed that the home has ensured that safe working practices are in place and all relevant safety checks regarding the environment were up to date. There is a development plan in place for the home so that ongoing maintenance is addressed. Accident and incident records were comprehensive and these then formed part of service users reviews and outcomes were incorporated into updated care plans. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 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 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 4 3 X X X 3 X 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13 (2) Requirement New boxes/bottles or courses of medication must not be opened and used prior to the original box/bottle or course being completed and disposed of appropriately. The home must ensure that there is a monitoring procedure in place to ensure that medicines are stored, administered and disposed of appropriately at all times – in that regular auditing of medication and competency checks for staff are carried out by a suitably qualified person at regular intervals. An action plan should be forwarded to the Commission within the timescale stated. Timescale for action 10/03/06 2 YA20 13 (2) 25/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 23 1 YA20 2 3 4 5 6 YA20 YA20 YA20 YA20 YA35 7 7 YA36 YA36 It is a good practice recommendation that when opening bottles or boxes of medication that the actual start date is noted appropriately on the vessel – so that staff are able to monitor administration, so as to further promote service user safety. It is recommended that MAR sheets are separated within the folder and that photographs are used to further identify service users. It is recommended that samples of signatures and initials are kept of all staff who administer medication. It is recommended that the temperature is taken on a regular basis of the storage area of medication. It is a good practice recommendation that any alterations to MAR sheets are signed and witnessed by 2 members of competently trained staff. It is strongly recommended that the training of staff is prioritised – in that those staff whose mandatory training is most urgent undertake their training on the first available courses especially with regards to Adult Protection. It is a good practice recommendation that staff read and sign the minutes / outcomes of staff meetings. It is a good practice recommendation that the manager aims as far as is practicably possible to maintain the planned supervision programme. 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone 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 74 Sir Evelyn Road DS0000040213.V283204.R01.S.doc Version 5.1 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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