Inspection on 30/01/07 for Alban House

This inspection was carried out on 30th January 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

Alban House 27/01/08

Alban House 15/11/05

Alban House 17/08/05

Alban House 26/01/05

Alban House 24/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Alban House 8/10 Apsley Terrace Highfield Road Ilfracombe Devon EX34 9JU Lead Inspector Andy Towse Key Unannounced Inspection 11:45 30 & 31st January 2007 th 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 Alban House DS0000022139.V302422.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. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alban House Address 8/10 Apsley Terrace Highfield Road Ilfracombe Devon EX34 9JU 01271 863217 NO FAX fran@albanhouse.co.uk 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) Mr David Svenson Mrs Frances Svenson Mrs Frances Svenson Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Mental registration, with number disorder, excluding learning disability or of places dementia (22), Mental Disorder, excluding learning disability or dementia - over 65 years of age (22), Old age, not falling within any other category (22) Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. MD age range 40 years and over The total number of registered placements is 22 (twenty two) Date of last inspection 15th November 2005 Brief Description of the Service: Alban House provides accommodation and varying degrees of care and support for 21 service users over the age of 40 years. The home promotes independence, choice and respect. The property is situated in the residential area of the coastal town of Ilfracombe. It is close to the facilities of the town centre and is easily accessed to all areas by local transport. The accommodation is provided on four levels and is unusual in that it is a large terraced house, which was formerly three separate houses converted to make one. The home is in the process of being updated and completely refurbished by the owners. There are a variety of private rooms and communal areas. All of the bedrooms are single, some with ensuite facilities. A shaft lift provides access to all areas. The home has accommodated service users’ pets where possible. Copies of previous inspection reports are available in the home. Fees charged range from £270.00 -- £400.00 per week. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over two days and a period of twelve hours. The information contained in this report came from responses from staff, residents and healthcare practitioners involved with the home, who completed surveys prior to the inspection and also from a questionnaire completed by the registered manager. This information was complemented by the inspection which comprised a site visit, a tour of the premises and discussions with staff and residents combined with examination of records including care plans. What the service does well: What has improved since the last inspection? Since the last inspection the residents have benefited from the ongoing improvement in the physical environment of the home which has been carried out as part of the schedules included in the home’s business plan. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alban House DS0000022139.V302422.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 Alban House DS0000022139.V302422.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The wellbeing of residents is ensured by an effective admission procedure which ensures that only those whose needs can be met are admitted to the home. EVIDENCE: The files of three residents were case tracked. These were all found to contain assessments. Two of the residents had complex needs. Their files were seen to contain various assessment forms. One file contained a shared assessment compiled by a social worker and a nurse, a nursing referral from a psychiatric unit and a care plan drawn up by Social Services. Another file contained nursing assessments and considerable information relating to this prospective resident’s needs, together with how these could be met by the home and arrangements for specific training to be available to staff in order that they could offer appropriate support and care. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 9 The information contained on these files demonstrated that the home obtained sufficient information, from a variety of sources, in order to ascertain whether the resident’s needs could be met by the home. A senior staff member said that the registered manager had visited the residents prior to their admission to assess their suitability to be accommodated at the home. The registered manger later confirmed this and said that it was part of the admissions process that whenever possible she visited prospective residents prior to their being admitted to the home. The home does not offer intermediate care. Alban House DS0000022139.V302422.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from well written and regularly reviewed care plans. Residents’ health is ensured by regular contact with healthcare professionals and an appropriate medication policy. EVIDENCE: The files of three residents were inspected. They were all seen to contain care plans. Care plans were well written and contained evidence that the respective residents had been involved in their compilation. In instances where resident(s) had been admitted under the Mental Health Act1983, the requirements relating to this had been fully considered and included in the care plan. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 11 Care Plans showed evidence that advice and guidance had been sought from relevant professionals relating to the specific needs of individual residents. This advice was then used in tailoring care plans to the individual needs of these residents. Care plans were regularly reviewed. One file examined showed that the resident concerned had been involved in the original compilation of their care plan. Thereafter, care plans were reviewed and where appropriate, relevant professionals were seen to have attended reviews as well as the resident to whom the plan related. Care Plans were seen to relate to all needs of residents’ lives and included reference to diet, personal hygiene, medication, assistance with feeding, eating, bathing and dressing. With one resident there was specific attention paid to risk assessments. Whilst the risk assessments focussed on the safety of this resident they also took into account the resident’s right to self-determination and the protection of his/her independence. The resident’s care plan was underpinned by reference to his/her independence, right to dignity, choice and fulfilment. This resident, whilst having a severe risk of falling, was in the care plan able to lead a very independent lifestyle. His/her care plan showed that he/she had been involved in its compilation, was aware of the risks inherent in maintaining independence and had made an informed choice after the risks had been fully discussed with him/her. Entries in records and on care plans showed that residents at Alban House have regular access to relevant healthcare professionals. Entries on records showed that residents’ health is monitored and that residents discuss health issues with staff who ensure that they then have appropriate support. Files showed one resident to have recently had chest x-rays, CT scans, an endoscopy and referral for physiotherapy. Other files showed advice from dieticians which had been incorporated into a care plan and which was seen to be actioned on the day of the inspection. The home has a written medication administration policy. Medication is supplied in monitored dosage form on a weekly basis and to ensure safety a staff member is designated to check and record that all medications are correct on arrival at the home. Residents are encouraged to be independent and those who have the capacity are encouraged to self medicate. This only occurs after risk assessments have been carried out and to ensure the safety of residents who self medicate, their competence to carry out this procedure is periodically reviewed. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 12 Homely medicines are kept in a separate cabinet and are used with the knowledge of the general practitioner. Staff who administer medication have completed the ‘Safe Handling of Medicines’ distance learning course. Records showed that the residents have regular access to a general practitioner. Residents are encouraged to visit the general practitioner at his/her surgery as the general population would do, rather than expect home visits and this encouragement of independence was commented on favourably by a general practitioner in a response to the pre inspection survey submitted by the Commission for Social Care Inspection (CSCI). Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 13 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a lifestyle which encourages independence, reflects their choice and meets their needs and expectations. Residents receive a varied diet, which is adapted to meet both their needs and preferences. EVIDENCE: Residents at Alban House are encouraged to be as independent as possible. Some residents take part in domestic activities around the home which enhances their independence. This varies from assisting with setting tables to doing laundry work. Within the home there are some activities arranged for residents. These include barbecues in the summer, trips out shopping to Barnstaple and the local Tesco supermarket. Within the home activities such as Bingo, carpet skittles and bowls have previously been arranged, but according to the manager and staff, there was little interest in these. This was confirmed by Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 14 three residents who in conversation said that they ‘didn’t want activities’ and said that they enjoyed watching television in their own rooms and organising their own lives to suit their own needs. They did refer to activities which they did participate in, an example being the barbeque, but many expressed a desire to be by themselves Residents are active in the local community. One spoke about going to a local public house, another about attending a local church, whilst another belongs to a voluntary organisation and one assists at a charity shop. The home, as stated previously, encourages residents to be independent and is currently working with one resident who wants to live independently in the community to develop the skills he needs to realise his/her aim and to find him/her appropriate accommodation. Four residents spoken to were in their bedrooms. Here they have televisions and tea making facilities and all were very content to be able to organise their own lives with assistance, where required from care staff and the management of the home. All residents confirmed that they could have visitors whenever they wanted and records showed that residents had the choice of who to see and who not to see. The home has a history of being very tolerant of residents bringing pets into the home and at the time of the inspection there was a resident with a pair of caged birds and another resident who had taken responsibility for a pet dog. This positive attitude towards pets is referred to in the home’s Statement of Purpose which states, ‘we are happy to consider each case dependent upon need and the amount of pets already at the home.’ Residents were complementary about the food they received at the home. They made comments to being fed well and the ‘food being good’. One talked about having a choice of food giving as an example steamed fish being available due to his/her dislike of battered fish. Meal times were seen to be relaxed, with residents having the choice of where they ate. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s complaints procedure and staff who are knowledgeable about the protection of vulnerable adults. EVIDENCE: All residents and prospective residents receive a copy of Alban House’s Statement of Purpose. This contains a copy of the home’s complaints procedure. The procedure allows for any resident to be assisted in contacting the CSCI at any time should they not wish to take their complaint to the management of the home. In conversation residents said that they would take any matters of concern or complaint to the home’s owners. Two of the residents spoken to had lived in other care homes, which they had left due to dissatisfaction with the service. Both of these residents said that they had no complaints about Alban House. In addition to the complaints procedure the home also has a complaints book in which residents are free to write down any issues which they would like addressing. This was seen to be used to differing levels by certain residents and in discussion the registered manager was able to demonstrate that issues raised had been addressed. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 16 Staff spoken to were aware of what constituted abuse. As part of the home’s rolling programme of training staff receive training relating to the protection of vulnerable adults, thereby giving them the knowledge and skills they need to recognise abuse and take appropriate action to stop it, and thereby protect residents. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in an environment which suits their needs and which benefits from ongoing refurbishment. EVIDENCE: Alban House is an older type property, which was originally three properties made into one. All residents occupy single bedrooms, many of which have ensuite facilities. The home is situated in a position which allows its residents to easily access the cafes, public houses, churches and other public resources which make up Ilfracombe’s facilities. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 18 The home has an ongoing programme of maintenance and refurbishment which is covered in annual schedules. This has included replacing windows, installing an ensuite, recarpetting designated areas and extending the dining area. In addition to this the home encourages staff to record any work connected to maintenance or health and safety and these records show that any such work is attended to. Internally the home has an appropriate standard of hygiene and cleanliness. Externally, there is a garden area to the front of the premises which is used for recreation, such as holding barbecues in the summer. To the rear of the property is a private garden area, part of which has been paved to make a patio area. Recent work on drainage pipes, in accordance with the building improvements section of the home’s business plan has been carried out allowing the manager to complete work to make this into a recreational area for residents. Residents can bring with them items of furniture and any objects of sentimental value. This has resulted in bedrooms being personalised to the level chosen by individual residents. Residents spoken to were content with the rooms they occupied and one commented favourably upon the installation of new windows in his/her room. Wherever possible residents are accommodated in rooms which meet their assessed needs. This was demonstrated by a resident with mobility problems being assigned a downstairs, very spacious room with showering facilities suitable to his/her needs. It was noticed that several bedroom doors and one bathroom door were fitted with Georgian Plate glass. Whilst these do obscure the view into the room, curtains or other means of ensuring privacy could be installed. This was discussed with the manager who agreed to make suitable arrangements to give more privacy. The home has several lounge areas which allow residents the opportunity to socialise in small groups or choose quieter places to make jigsaws or read newspapers away from those who want to watch television in a communal room. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 19 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. Residents are supported by an appropriately trained staff group who are aware of their needs. EVIDENCE: Alban House has a stable staff group. Rotas and observation on the day of the inspection showed there to be appropriate numbers of staff on duty to meet the needs of residents. Generally residents spoke positively about the staff. Comments such as ‘you couldn’t get a better place than this,’ ‘the staff do anything for me’ and ‘they feed me well and look after me well’ were made. The proprietors have also attained the ‘Investors in People’ award and have received a positive review report which emphasised the good working relationship between the proprietors and the staff group in the home. The proprietors have demonstrated a commitment to training and over half of care staff have now achieved their NVQ 2 award with others still being assessed. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 20 The home has a rolling programme of staff training which includes statutory training such as Moving and Handling, Food hygiene, First aid, Health and Safety and the Protection of Vulnerable Adults course. In addition to this, some staff have participated on specialist training relating to the care of people who have dementia. Separate training and advice has also been given to staff relating to the specific needs of certain residents. Newly recruited staff who have not got NVQ 2 qualifications participate on an induction programme which is compatible with the Skills for Care programme. Staff files were examined. These were seen to contain police checks and two references. In one instance where a staff member had come from abroad, checks were made regarding his/her background to ensure the safety of residents. There was discussion with the registered manager regarding the need to ensure that no staff commenced employment before the home had received notification that they were not on the register for the Protection of Vulnerable Adults. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 21 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from a well managed home. In developing the service it would be beneficial if the opinions of residents were more regularly sought through the use of quality assurance questionnaires and more frequently held residents’ meetings. The home operates a good system of maintenance. EVIDENCE: The registered manager is a qualified nurse and has substantial experience of care including her time managing Alban House. She is competent and Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 22 responses from staff to the pre inspection survey and during the inspection showed that she is available to offer them support, direction and leadership. She has attained her Registered Manager’s Award. The other owner is currently taking his Registered Manager’s Award. In discussion the registered manager was able to show that Alban House had in previous years carried on Quality Assurance and Quality Auditing by using questionnaires forwarded to staff and residents. These audits related to issues such as the quality of care, however they have not been carried out recently. Another useful forum for obtaining the views of residents regarding aspects of the service is that of residents’ meetings. Minutes showed that whilst these are convened, they do not take place regularly, with the most recent minutes referring to a meeting which took place in July 2005. Residents are encouraged to be as independent as they are able. Wherever possible the home encourages them or their relatives to manage their own finances. In instances where the home holds money for residents all transactions are recorded and wherever possible receipts are retained. The system in operation protects residents and they are also encouraged to open post office accounts. The residents’ safety is protected by the home having a good system of risk assessments and records showed that there is a regular servicing of equipment such as hoists and lifts. The electrical installations within the home were being serviced at the time of the inspection. All accidents are recorded, even when not witnessed. At the time of the inspection residents’ safety was prejudiced by the use of some doors, labelled as fire doors, being wedged open. This was brought to the attention of the registered manager who immediately removed the wedges and made assurances that they would not be used again. Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 23 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 24 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 OP33 Regulation 24 Requirement The registered person shall establish and maintain a system for a) reviewing at appropriate intervals; and b) improving, the quality of care at the home The system shall provide for consultation with service users and their representatives. Timescale for action 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alban House DS0000022139.V302422.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Alban House DS0000022139.V302422.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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