Inspection on 05/09/07 for Abbeyfield The Dynes

This inspection was carried out on 5th September 2007.

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

Other inspections for this house

Abbeyfield The Dynes 10/10/06

Abbeyfield The Dynes 14/12/05

Abbeyfield The Dynes 28/06/05

Abbeyfield The Dynes 28/09/04

Abbeyfield The Dynes 19/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Abbeyfield The Dynes Nightingale Road Kemsing Sevenoaks Kent TN15 6RU Lead Inspector Debbie Sullivan Key Unannounced Inspection 5th September 2007 09:00 X10015.doc Version 1.40 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 Abbeyfield The Dynes DS0000024033.V346353.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 Older People. 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. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeyfield The Dynes Address Nightingale Road Kemsing Sevenoaks Kent TN15 6RU 01959 523834 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 Abbeyfield Kent Society Post Vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th October 2006 Brief Description of the Service: The Dynes is a purpose built home for older people situated in a quiet part of Kemsing village. The home is in close proximity to local shops and there is a bus service to the village connecting with Sevenoaks. Residents are mainly accommodated in single bedrooms although there is the provision of a double bedroom if requested. All bedrooms have an alarm call system and residents are encouraged to personalise their rooms. A shaft lift provides access to all areas of the home. There are a range of communal areas and a well kept, safe and attractive garden is accessible to residents. Residents have opportunities to take part in some activities provided by the home and work is taking place to increase the choice of activities available in house and in the community. Staff are well trained and the majority hold an NVQ in care qualification. The current weekly fee for the service ranges from £396.43 to £560 per week. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection of The Dynes took place over seven and a half hours. During the visit time was spent with the manager, service users and staff and relatives who were visiting. The home was toured and a range of records and documents were read. Throughout the visit the manager and staff were helpful in providing information and assisting the inspection. The home is in the process of change and whilst there is still need for improvement, especially in terms of activities and environmentally, it was clear that the manager and staff are committed to progressing these and the organisation is supporting them to do so. What the service does well: What has improved since the last inspection? Since the last inspection an overall programme of improvement has been planned for the home, the new manager has been in post since May 2007 and has been working towards improving several areas including the standard of accommodation, provision of activities and staffing levels. Recent recruitment has led to an increase in the number of care staff, which in turn is beginning to allow for the provision of more activities. The home was identified in the last report as being in need of refurbishment, work on this has started with some areas including the dining room having been repainted and some new furniture and carpets have been purchased. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 6 All the bedroom carpets in one area of the home have been replaced. Some parts of the garden are being improved and made more attractive for service users to sit in. The menu is being extended and a second chef is being employed. Care planning documentation has been made more accessible for staff and service users, and daily recording is more thorough. 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. The summary of this inspection report can be made available in other formats on request. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are able to access information about the home and visit before making a decision to move in. Needs are fully assessed before a place is offered. EVIDENCE: The home has a statement of purpose and service users guide, prospective residents have opportunities to visit the home before moving in or relatives can do so on their behalf. One service user spoken with said that their son and daughter had chosen the home having visited first. Another said their care Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 9 manager had arranged for them to move there and they were pleased they had as they were very satisfied with the service. The manager or a senior member of the care staff visit prospective residents at home or in hospital to assess their needs before a decision is made to offer a place. The assessment document is thorough and information is subsequently transferred to the care plan. If a resident has been admitted to hospital a reassessment takes place so that the home can be sure it can still meet needs in full. Residents who were spoken with in person, or who sent in survey forms, felt the home met their needs. The service does not provide intermediate care. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan that accurately reflects his or her health and personal care needs and needs are well monitored and reviewed. Medication policies and procedures serve to protect residents. EVIDENCE: Each resident has a care plan and there is additional information available in terms of assessment information that is transferred to the main care plan. The new manager has progressed the revision of care plans so that the information in the main working file is up to date, more accessible and clearer for staff and accurately reflects the daily needs of residents. Daily log recording is included and it is now completed in enough detail to give a picture of the overall daily life of the resident including any activities undertaken, visits from Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 11 relatives, and any concerns noted for example about mood or health. Risk assessments are in place and care plans are reviewed monthly. Good health is promoted and care plans showed that contact is maintained with a range of health professionals including district nurses, chiropodists and hospital consultants. Weight is monitored and the manager is introducing more monitoring of nutrition. If there is a change of needs specialist advice is sought, a review had recently taken place for a case tracked service user that had included their care manager with the outcome that referral to a health specialist was recommended. The home had already been pro active in asking the GP for this input and the manager was putting measures in place to meet changed needs. Some residents have sight or hearing loss, the manager is looking into the provision of a loop system for those with hearing loss and staff receive training on sensory impairment to enable them to understand these specialist needs. A part of the garden has recently been redesigned to include wind chimes and a water feature for those with poor sight to enjoy. Medication is appropriately stored and all staff receive medication training, team leaders are responsible for administering medication, MAR sheets were correctly completed. It is a recommendation that the list of staff trained to administer medication be brought up to date. Residents spoken with said that staff respected their privacy and dignity and are respectful this was seen to be the case overall although during the inspection care staff were observed weighing two residents in a communal area. This was addressed with the manager and a team leader and whilst it was said not to be the usual procedure, the manager undertook to clearly remind staff that this was not acceptable practice. The manager said that recently the organisation had ensured that wishes in the event of terminal illness and death were recorded. Residents are able to stay at the home as long as their needs can be met. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to maintain contact with relatives and friends and are able to make choices about their daily lives. The provision and choice of activities is being improved upon following consultation with residents. EVIDENCE: The last report recorded that few activities were provided at the home, the new manager recognises this and along with other improvements planned is working on increasing the range of activities on offer at the home and in the community. Residents have been consulted as to their wishes that include learning IT skills and a language, Age Concern and a local school have been approached about providing these opportunities. In house activities are planned to include flower arranging and gardening with the planned provision of a raised vegetable garden. Staffing levels at the home Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 13 have not recently allowed for care staff to give a lot of time to socialising with residents or providing activities. Now that successful recruitment has taken place it is hoped that staffing hours can be restructured to include regular time away from the direct provision of care. Some staff have identified activities they would like to offer such as reading to residents, playing scrabble with them and gardening. During the inspection the home hosted a clothes sale for the first time that was very well received by residents and relatives who had come in to help residents choose clothes. Feedback was that it was an opportunity for those who could not get to shops to try on clothes and items were good quality; further sales will be booked in. Although there are not currently many structured activities those residents spoken with said they mostly had enough to do. One was enjoying sitting in a patio area, said they liked walking in the garden and spoke of going to the local heavy horses show with a member of staff who was on their day off at the weekend. The resident used to work with horses and had been visited in the morning by an off duty staff member who had taken the trouble to bring in two other visitors experienced in working with horses to share experiences. Another resident had enjoyed a “pub crawl” with other residents and staff; this was later identified as a pub lunch. Visitors are welcomed and several were at the home during the inspection, some residents have their own phones and a private telephone area is available. Those spoken with said that they could make choices about their daily lives and that they were satisfied with the meals provided. The menu offers a choice of daily main and evening meal, the lunch was well presented and the dining room has recently been made more attractive. The manager is promoting increased awareness of good nutrition with some changes to the menu; a second chef was due to start work the week after the inspection who was experienced in the field of nutrition for older people. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be sure that any concerns or complaints will be taken seriously and addressed. Residents are protected from abuse by the policies and procedures in place at the home. EVIDENCE: The home has a complaints procedure; since the new manager had been in post four formal complaints had been recorded and been properly responded to. One remained outstanding and work was taking place to address it. One was not directly about the service but an organisational matter the home had responded to. Outcomes of complaints are recorded. Residents spoken with said they would tell staff of any concerns and one resident said they were sure their relatives would advocate for them. During the inspection a service user approached the manager about something that was worrying them and was reassured. The home has an adult protection and whistle blowing policy and staff receive POVA training. The manager was due to attend a course to equip her to Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 15 become a POVA trainer. There are no adult protection alerts in respect of the service. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, comfortable, and homely, the plans for refurbishment underway and in place will improve both shared and individual space for residents. EVIDENCE: The home provides a comfortable and homely environment for residents. It is needing refurbishment as it is still rather “tired” looking in some areas, a programme of refurbishment has started and some redecoration had taken place and was on progress. The dining room has been repainted and fitted with some new windows and throughout the building where there has been most urgent need, new furnishings have been provided. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 17 The bedrooms are on the ground and first floor, some ground floor rooms are in relatively new wings of the building and have more space than the original rooms. All the bedrooms are personalised and residents bring in their own furniture as far as possible, rooms visited were personalised with pictures, photos and ornaments as well as furniture. Residents spoken with liked their rooms and on moving in they can choose to have their room repainted and recarpeted in their choice of colour scheme. There are several lounge/sitting areas of various sizes, this help to give a homely atmosphere; again some need more refurbishment than others. There are plans to make one room a 1940’s lounge. During the inspection residents and relatives were accessing all communal areas freely. There is a large, attractive garden, a rose bed area with benches is being prepared and a Japanese style patio area has been developed this year. This provides a sunny space for residents to access safely if they do not wish to venture further into the garden, there is also another pleasant patio area. There are two shower rooms and an assisted bathroom; the bathroom and shower room in the older part of the building need refurbishment as do some toilets. Equipment for individual or shared use is in place throughout the home and corridors are fitted with handrails. There is a dedicated hairdressing room, the hairdresser visits once a week and was there on the inspection day, the room was busy all day and residents were enjoying having their hair done. The home employs domestic staff, it was clean and any untidy areas were due to refurbishment underway. A maintenance man is also employed who is responsible alongside the manager for ensuring that safety and equipment checks take place. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of residents are met by a well trained, confident and well supported staff group. Recruitment procedures are through and recent recruitment is strengthening the staff team. EVIDENCE: The home had been experiencing a period with care staff vacancies, there has been emphasis on recruitment and the home is now nearly fully staffed. A new member of the care staff who had just joined the home was shadowing other staff as part of their induction and said they were really enjoying it. There are three care team leaders. There was still a need to employ some agency carers but this was decreasing. As well as care staff administration, maintenance, domestic and catering staff are employed and there is a part time gardener. The home has a number of volunteers and there is a Friend of The Dynes group, a volunteer provides a shop at the home once a week. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 19 Staff are well trained and the organisation provides training internally and from a range of external providers, the manager was shortly going on training to become a P.O.V.A trainer. The majority of care staff have obtained an NVQ in care qualification, a staff member spoken with was due to start NVQ 3. Comments on survey forms and made in person by residents and relatives were complimentary about staff, comments included “There is not one of them that won’t do anything for me”, “They care as much as they can” and “The caring is excellent”. Reference was also made on survey forms to shortage of staff being a problem lately especially in holiday times, the manager acknowledged this and recent recruitment is intended to improve the situation. A staff member confirmed staffing was improving. Staff observed during the inspection had good rapport with residents and were confident. Staff receive regular recorded supervision and team meetings are held. A sample of staff files were read, they included those of a carer recently recruited and a long standing carer, recruitment procedures are robust and the manager will check the organisation’s policy on renewing CRB disclosures. A team leader who had been employed at the home for many years confirmed that they had had a CRB check. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of staff and residents and has a pleasant and friendly atmosphere. Residents and staff are protected by the home’s and organisation’s policies and procedures. EVIDENCE: The new manager has been in post since May 2007, they are suitably experienced, due to commence the Registered Managers Award training in Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 21 October and are gong to submit paperwork to apply for registration with the Commission. The manager has prioritised the main areas where systems, staff support, environment and direct care and provision of activities for residents can be improved upon and a lot of work to implement these has already taken place. The manager has a clear vision for the future of the service and is committed to enabling staff to develop their skills. The atmosphere in the home is open, relaxed and friendly a relative included the comment “I am very happy with the care my (relative) receives. I also like the informality of the home which suits my (relative) well” The views of residents are sought via surveys and residents meetings, relatives and outside professionals are also surveyed and families meetings are held. Residents had had opportunities to offer their views on meals and activities they would like. The provider undertakes Regulation 26 visits although they are not currently monthly and the frequency needs to be increased. The home has a valid insurance certificate. Policies and procedures are in place to ensure the efficient running of the home and to protect residents and staff, some were read and they are reviewed by the organisation. Safe working practices are followed and fire equipment regularly serviced, fire practices take place, fire alarms had once gone off for no known reason this year and this had presented staff with the opportunity for additional practice. The manager said they were pleased with the actions of staff. Records relating to residents and staff are securely and confidentially kept. Abbeyfield The Dynes DS0000024033.V346353.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 3 Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 23 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 OP10 Regulation 124(a) Requirement “The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users” In that residents must not be weighed in any communal area, all health and personal care tasks must take place in private. The manager took immediate action to address this during the inspection. 2. OP33 26(2)(a) (3) “Where the registered provider is an organisation the care home shall be visited in accordance with this regulation by the responsible individual or one of the partners. Visits shall take place at least once a month and be unannounced.” In that whilst R 26 visits are taking place the frequency must be increased to monthly. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 24 Timescale for action 07/09/07 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP15 Good Practice Recommendations It is recommended that he list of staff trained to administer medication be brought up to date and kept under review. It is recommended that information on the daily menu be displayed more clearly in the dining room. Abbeyfield The Dynes DS0000024033.V346353.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Abbeyfield The Dynes DS0000024033.V346353.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. 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