Inspection on 16/08/07 for Aldercar Care Home

This inspection was carried out on 16th August 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

Aldercar Care Home 06/07/06

Aldercar Care Home 09/01/06

Aldercar Care Home 11/05/05

Aldercar Care Home 25/10/04

Aldercar Care Home 28/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Aldercar Care Home 36 Wood Lane Hucknall Nottingham NG15 6LR Lead Inspector Richard Ramsden Unannounced Inspection 10:00 16 August 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 Aldercar Care Home DS0000008615.V340670.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. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aldercar Care Home Address 36 Wood Lane Hucknall Nottingham NG15 6LR 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) 0115 963 7797 0115 956 6531 Mrs Amirchetty Anuradha Rao Mrs Amirchetty Anuradha Rao Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. One bed is registered for D(E) for the named Service User as stated in the Notice of Proposal. The placement is reviewed by the end of January 2006. Staff are provided with Dementia training. Date of last inspection 6th July 2006 Brief Description of the Service: Aldercar is 28 bedded home offering personal care to older people. The home is located in a quiet residential area in Hucknall, a small town, which has local community facilities, shops and there is easy access to public transport. The home is set in attractive gardens, providing a pleasant outlook for the majority of bedrooms and communal areas. There are 2 double and 24 single bedrooms. The majority of the bedrooms are available on the ground floor and a stair lift provides access to the four single rooms available on the first floor of the home. There is a choice of lounge areas, including a conservatory. There are a variety of aids and adaptations throughout the home, including assisted bathing facilities. The homes current weekly fee range is £300 to £344. A copy of the most recent inspection report was available in the home. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector completed this unannounced visit over one day it took approximately 7 hours. It included the inspection of care and other records, a discussion with the registered manager, the care manager, one member of care staff and the cook. The inspector spoke with three residents and two visitors to the home. Two service user satisfaction questionnaires and two carer / relatives satisfaction questionnaires were received prior to the inspection. A partial tour of the building was also completed. Three residents were Case tracked, which means that their care plans were examined against the actual care they receive. The care manager informed the inspector that the home had recently been registered to accommodate people with dementia and that they were expecting a new registration certificate in the near future. Prior to completing this visit the inspector assessed the homes service history and the last inspection report. What the service does well: The people living at Aldercar Care Home and their representatives are generally very satisfied with the services provided. The home is well managed and run in the best interests of the residents. Residents and staff spoken with during the inspection confirmed that they have confidence in the managers’ abilities and that she involves them in the decision-making within the home. Residents meetings and frequent discussions with the care manager also helps to ensures that people living at Aldercar are able to voice their opinions about the way in which the home is run. People said that they are very satisfied with their bedrooms and confirmed that they had been encouraged to personalise them with small items of furniture photographs etc. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 6 The care staff are well trained and many have worked at the home for a long time. This experience and training helps to provide continuity and stability for the residents. Residents said that the home provides a good programme of activities and entertainment. One person said that he has a vegetable plot where he grows is own fruit and vegetables. Care plans are comprehensive and reviewed frequently enough to ensure that staff always know what assistance and support each resident requires. Health care records are particularly well maintained. Residents said that staff are always friendly and respectful and ensure that their privacy and dignity is maintained at all times. Two people said that the staff are always busy but still find time for a laugh and a joke. The observed interaction between staff and residents was of a very good standard. What has improved since the last inspection? What they could do better: An assessment must be made of residents needs to ensure that appropriate staffing levels are provided. The homes fire systems must be tested at least once a week and anything, which could affect the well being of the residents, must be reported to the Commission without delay. Some minor improvements to records kept about individual residents would be beneficial. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 7 More detailed records of the food provided to residents would show what alternative food is available if people do not want the meal suggested on the menu. The information gathered as part of the Quality Monitoring system should be used to produce an annual development plan for the home,This could be made available so that people can see that the information they provide is being used to develop the services at the home. 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. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 8 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 Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 9 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): 1,2. The staff are ensuring that they can meet the needs of prospective residents by obtaining pre admission assessments. Residents are issued with a written contracts/terms and conditions of residence. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents records were assessed as part of this inspection. The records of the most recently admitted resident contained a preadmission assessment, which had been completed by a social worker. The other records belonged to two people who had lived in the home for some considerable time. The care manager said that preadmission assessments had Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 10 been obtained for these residents but that they had been archived. She confirmed that residents are never admitted without a preadmission assessment. The manager was reminded that the preadmission assessments should be kept on the individual residents files and available for inspection. All of the residents records, checked during this visit contained terms and condition of residence documents, which had been signed either by the resident or their representatives. (This is good practice). Aldercar Care Home does not provide intermediate care. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 11 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. Residents individual care plans contain sufficient information and are reviewed regularly enough to ensure that staff are aware of what support and assistance of each resident requires. The homes medication is well managed and residents believe that they are treated with respect. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents care plans were viewed as part of this inspection. The care plans contained sufficient information and were reviewed frequently enough to ensure that staff always have up-to-date information about the care and support each resident requires. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 12 The care plans viewed during the inspection had not been signed by the individual residents, or their representatives, to confirm their involvement in the care planning and review process. Records show the residents health care needs are being appropriately met this was confirmed by three of the residents and two visitors who were spoken with during the inspection. A district nurse manager, who was in the home at the time of inspection, also made very positive comments about the way in which staff manage residents’ health care needs. All of the residents bathing records are recorded on one sheet and consequently cannot be viewed in a confidential format. The homes medication systems have been well maintained. Basic risk assessments are available for residents who wish to manage their own medication. However these risk assessments need to contain more detailed information to ensure that residents are aware of the dose and time at which their medication should be taken. The records of receipt and disposal of medication have all been well maintained and the medication is stored securely. The care manager was advised that staff must check and record the temperature in the refrigerator where medication is stored. Medication, particularly insulin, can deteriorate and become less effective if not stored at the appropriate temperatures. None of the residents had controlled medication at the time of this inspection, however appropriate record keeping and storage was available. All of the residents spoken with said that the staff are friendly and respectful and ensure that their privacy and dignity is maintained at all times. The visitors spoken with during the inspection also confirmed this. The observed interaction between staff and residents was an excellent standard. Aldercar Care Home DS0000008615.V340670.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. The lifestyle experienced in the home appears to match the residents’ expectations and preferences. People are encouraged to main contact with family and friends; residents are satisfied with the food provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was able to demonstrate that the home provides a good range of activities and entertainment to stimulate the residents. The programme of activities is displayed in the home and activities newsletter is produced each month. (This is good practice). The residents spoken with confirmed that the home does provide a good variety of activities although one person stated that she chooses not to participate in the activities provided. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 14 Residents and two visitors confirmed that visitors are made welcome, in the home at any time and that refreshments are always provided. The two visitors spoken with said is that they visit their relatives on a daily basis. Individual residents care plans give details of how residents can be encouraged to make decisions about their daily lives. (This is good practice). There are also residents meetings where people are encouraged to express their opinions about the way in which the home is run. All of the residents spoken with said that they are very satisfied with the meals provided by the home and that alternatives will be provided if they do not want the food suggested on the menu. The lunch on the day of inspection was well balanced and appetising. One resident who staff stated was a vegetarian had the same meal as the other residents but without any protein. The staff stated that the resident is unable to express a preference about the food she receives. However her family have stated that she does not like processed vegetarian meals and would prefer just to have the vegetables and gravy. Staff confirmed that this resident does eat fish when this is on the menu. The manager was advised to look at ways of providing the resident with alternative meals suitable for vegetarians. The home has a four weekly rotating menu, however this does not give details of what food is available if people do not want the meal suggested on the menu. Aldercar Care Home DS0000008615.V340670.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): 16.18. The home has an accessible complaints procedure and staff are ensuring the residents are protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the home and in the literature supplied prospective residents. The homes complaints records show that there has been one complaint received since the last inspection. This complaint was investigated by social services. The residents spoken with confirmed that they would speak to the care manager if they had any concerns or complaints. They all believe their concerns would be dealt with appropriately. All staff have received basic training in Safeguarding Adults since the last inspection and the home has an appropriate Whistle Blowing Policy. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 16 The member of staff spoken with during the inspection was clear about her responsibility to report any possible abuse she may observe. Aldercar Care Home DS0000008615.V340670.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): 19,26. The extended accommodation has been maintained to a very good standard. It was pleasant and hygienic at the time of this inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial tour of the premises was completed as part of this visit. The accommodation has been maintained to a good standard. The residents bedrooms viewed during this visit were comfortably furnished and people had clearly been encouraged to personalise their rooms with photographs, ornaments and small items of furniture. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 18 All of the residents spoken with stated that they liked their bedrooms and confirmed that they can use them at any time. It was noted that the home has a number of portable air-conditioning units, which are situated, in the communal areas, to ensure that there is adequate ventilation. At the time of inspection one of the bathrooms was being refurbished to provide additional assisted bathing facilities. All of the residents and visitors spoken with during the inspection confirmed that the home is always clean and hygienic. The gardens are a particular feature and residents said how much they enjoy sitting out in the sunshine. An area of the garden has been enclosed so that people with poor short-term memories can have safe access to and outdoor space. (This is good practice). Aldercar Care Home DS0000008615.V340670.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): 27,28,29,30. At some periods during the afternoon there are insufficient staff on duty to meet the assessed needs of the residents. The homes recruitment policies and practices are supporting and protecting residents. The registered person was able to demonstrate a commitment to staff training and development. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rota provided for the week of inspection showed that when the care manager is off duty there are only two members of care staff to provide care and assistance to the residents. The information provided by the manager prior to the inspection shows that six of the residents have high dependency needs and required two members of staff to assist with their personal care. Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 20 The two members of staff on the afternoon shift not only have to provide personal care and assistance to the residents but also have two prepare and serve the teatime meal. The staff and all of the residents spoken with said that they do not believe there are always sufficient staff to meet the residents assessed needs. Residents said that the staff are excellent, they work extremely hard and will do anything they are asked. However residents confirmed that sometimes they have to wait a considerable time before staff are available to offer them assistance with their personal care. All new members of staff complete an appropriate induction training programme. The inspector was informed that all, except two recently recruited members of staff, have completed their NVQ level 2 or above. (This is good practice). The staff training records viewed during this visit show that a considerable amount of training has been provided. All staff have now received training on working with people who have dementia. The homes recruitment policies and procedures include aspects of equal opportunities to ensure that there is no discrimination. The personal records of two members of staff were assessed as part of this visit. The records had been well maintained and contained all the required information. The manager confirmed that staff do not commence employment until all the required information has been obtained. Aldercar Care Home DS0000008615.V340670.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): 31,33,35,38. The home is well managed and run in the best interests of the residents. Where checked the health and safety of residents and staff is generally promoted and protected. Fire records must be more accurately maintained. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is very experienced and has completed the Registered Managers Award. The manager stated that the organisation who provided her management training are no longer trading & have failed to provide her with a Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 22 certificate to confirm that she has successfully completed the training. Her work has been submitted to a local college who will arrange for the work to be moderated and hopefully provide the appropriate certification. One and the Residents’, staff and visitors said that the manager and care manager are very approachable and that they seek their views about the way in which the home is run. Quality monitoring systems are in place and the management staff use the information gathered to help develop the services provided. It was suggested that the information gathered should be used to produce an annual development plan for the home. Staff do manage some residents personal money, the records were checked at random and were well maintained. A fire risk assessment has been completed since the last inspection in consultation with the fire officer. The homes Fire records had generally been well maintained however it was noted that there were occasions when the homes Fire Systems had not been tested every week. Although the home is completing regular fire drills they are not recording the names of the staff that are participating in the fire drills. It is therefore very difficult to ensure that all staff are attending at least one fire drill each year. Regulation 37 When the homes service history was checked, prior to this inspection, no residents’ deaths had been reported to the Commission for social Care Inspection. During the inspection the care manager confirmed that there had been a number of deaths in the home and in hospital since the last inspection. She stated that she was not aware that these had to be reported under Regulation 37. The inspector discussed the incidents that need to be reported under this regulation. Aldercar Care Home DS0000008615.V340670.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 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 X 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Aldercar Care Home DS0000008615.V340670.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 OP9 Regulation 13(2) Requirement Timescale for action 16/08/07 2. OP27 18 (a). Staff must record, each day, the temperature in the refrigerator where medication is stored. Medication can deteriorate and become less affective if stored at the wrong temperature. The registered person must carry 17/09/07 out an assessment of service users needs and ensure that there are appropriate staffing levels to meet the health, safety and welfare needs of the residents accommodated in the home. 3. OP38 4. *RQN 23 (4) (c). The homes fire systems must be 16/08/07 tested at least once each week & the results of the tests must be accurately recorded in the homes fire records. The names of the staff participating in fire drills must be recorded to ensure that all staff attends at least one fire drill each year. 37. The registered person must 16/08/07 inform CSCI without delay of any incident listed in Regulation 37. Including the death of any resident. DS0000008615.V340670.R01.S.doc Version 5.2 Page 25 Aldercar Care Home 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. 3. Refer to Standard OP1 OP7 OP7 Good Practice Recommendations The residents pre admission assessments should be kept with their care plans. Residents bathing records should be recorded on separate sheets for each resident so that the information can be viewed in a confidential format. Where possible residents or if appropriate their representatives should sign their individual care plans to confirm their involvement in the care planning and review process. The risk assessments for those residents who wish to administer their own medication should contain more detailed information, to ensure that the residents are aware of the dose and time at which medication should be taken. The menus should include details of what food is available if residents don’t want the meal suggested on the menu. The registered person should look at ways of providing a more varied & nutritious diet for residents who are vegetarian. The registered person should use the information gathered as part of the homes Quality Monitoring system to produce an annual development plan for the home. This could be made available so that people can see that the information they provide is being used to develop the services provided. 4. OP9 5. 6. 7. OP15 OP15 OP33 Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Aldercar Care Home DS0000008615.V340670.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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