Inspection on 02/08/05 for Almond Villas

This inspection was carried out on 2nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Almond Villas 13/02/09

Almond Villas 11/04/07

Almond Villas 10/01/06

Almond Villas 11/10/04

Almond Villas 27/04/04

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

CARE HOME ADULTS 18-65 Almond Villas 3-5 Dukes Brow Blackburn Lancashire BB2 6EX Lead Inspector Jane Craig Announced 02 August 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Almond Villas Address 3-5 Dukes Brow Blackburn Lancashire BB2 6EX 01254 681243 01254 605038 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Marilyn Clarke Mrs Marilyn Clarke Care Home Only Personal Care (PC) 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) 14 of places Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Almond Villas is one of a group of three care homes offering 24-hour accommodation, support and rehabilitation programmes for 14 adults with mental health needs. The registered provider and manager for the group is Mrs Marilyn Clarke. A team of managers, each with designated responsibilities, share the day to day management of the three houses. Accommodation at Almond Villas is provided in six self-contained flats. Four flats contain three single bedrooms with a shared lounge, kitchen and bathroom; the other two are single person flats. Communal areas, including a group/training room, counselling room/quiet lounge and laundry are housed in the basement. The offices and staff facilities are also on this floor. Almond Villas is a detached, converted property located in a residential area close to Blackburn town centre. There is a small patio/garden area at the front entrance. There is no parking at the house but street parking is available approximately 100 yards away. The main road into Blackburn, with a bus stop, shops and other amenities is within easy walking distance. Almond Villas provides a safe environment where service users are encouraged and supported to engage in decision making and rehabilitation programmes in preparation for independent living. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which meant that the residents and staff were told beforehand when the inspector would be arriving. The inspection took place over one and a half days. At the time there were 13 residents accommodated in the home. The inspector met with 7 residents. Wherever possible they were asked about their views and experiences of living at Almond Villas and some of their comments are quoted in this report. Comment cards had been sent out to residents and visitors prior to the inspection. 6 were returned; all with positive comments. During the course of the inspection discussions were held with the registered provider, four other members of the management team and 3 support staff. A partial tour of the premises took place and a number of documents and records were viewed. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: The process for assessing and admitting new residents was very thorough. Staff from the home had several meetings with the prospective resident and other people involved in their care. This ensured that staff fully understood the resident’s needs before they were offered a place. The prospective resident also visited Almond Villas and had overnight stays before they made a decision whether the home was right for them. Staff had good opportunities for training. New staff went through a thorough induction programme, which helped them to understand the needs of the residents and to learn how to give the right support. Staff said that they were encouraged to attend any courses that would help them in their work with residents. Residents said that the staff were well trained. One said, “the staff are very good, they know what they are doing.” Residents said that they always had enough to keep them occupied. They talked about groups that helped them to build confidence and skills to help them to move on. Other residents talked about leisure and recreational activities that were organised by staff or the residents themselves. One resident said, “they’re really good with activities and things.” Residents and staff got on well together. Comments about the staff included “they’re brilliant”, “really supportive”, “they always know what to do to help” Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 6 and “staff are friendly and helpful.” One resident who was due to move out said, “the staff are great, Almond Villas have done their job.” What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 and 5 There was an excellent admission procedure, which ensured that staff had a clear understanding of the resident’s needs and how they were to be met. Prospective residents had ample opportunities to visit the home, which helped them to make a decision about whether the placement was suitable for them. EVIDENCE: There was an extensive pre-admission assessment process, which often took several months to complete. Assessment information was obtained from all appropriate sources and communicated to the staff team before the resident was admitted. The resident, their family and health care professionals were fully involved in the process. A trial period care plan was drawn up on admission. Prospective residents made the decision to move to the home only after a series of visits and short stays. Two residents talked about their experiences of moving into Almond Villas and said that being able to talk to other residents and meet staff had helped them to make a decision. All files seen contained a statement of terms and conditions of residency, which included signed agreement from the resident. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 The care planning process enabled residents to be involved in setting their own goals and ensured that staff were provided with sufficient information to help residents to meet their needs. The risk assessment and management framework supported residents to take responsible risks and work towards independent living. EVIDENCE: On admission all residents completed a care plan assessment with their keyworker. The assessment identified the resident’s perspective of their strengths, needs and goals and covered all aspects of their past and present situation. Care plans were drawn up from this information. Most plans contained detailed instructions as to how the resident’s needs were to be met and by whom. However, the plan for one recently admitted resident was not detailed enough to ensure that staff were able to provide consistent care. Plans were reviewed and updated as and when any changes occurred and all residents had a formal, multi-disciplinary review at least every six months. Residents were involved in drawing up and reviewing their plans. One resident said “they did my plan with me and I signed it.” Another said “they don’t just put things down, you talk about it and come to a decision about what you are Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 10 going to do.” Not all plans were signed and dated by the member of staff involved in drawing them up. There was a policy on risk taking and risk management. All files contained risk assessments and detailed risk management strategies specific to the resident. Staff gave examples of how residents were supported to take risks, usually by gradual exposure to risk situations and continual re-assessment. One resident talked about how the staff helped them to move on by taking every day risks and another said, “we are not wrapped in cotton wool.” Any limitations or restrictions were agreed by the resident, staff and other professionals involved in their care. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 14, 16 and 17 Residents were provided with very good opportunities to engage in a wide range of appropriate activities and were supported to use community facilities. The home’s policies and staff practice ensured residents’ rights were upheld. Residents were supported to choose, plan and cook their own meals to increase their independent living skills. EVIDENCE: Residents drew up a weekly programme with their keyworker. Each programme included a wide variety of therapeutic and leisure activities designed to develop skills and move towards independent living. All of the residents spoken with were very positive about their programmes. One said, “they’re really good with activities and things.” Another resident said “there’s always something to do but you don’t have to join in if you don’t want to.” Several mentioned how much they enjoyed the task group, where residents agreed to undertake tasks set for them, for example, finding out information in and around the local community. One resident said, “it helps us build up skills to help us when we leave.” All residents were encouraged to use community facilities, either independently or with staff. Some residents were taking Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 12 college courses. Voluntary work was an option for those who wanted to pursue it. Several residents spoke about a recent holiday and several day trips. A service user forum had been established since the previous inspection. The aim of the group was to participate in some management decisions and take a role in the development of the service. Residents said that routines were flexible. They said they were expected to be up by a certain time and to join any groups or activities they had agreed to. Two residents said there were some house rules but they were not “unreasonable.” Staff spoke about residents respectfully. They were very aware of residents’ rights and said that part of their role was to ensure that they were upheld. Residents all said that staff treated them with respect. Part of the residents’ programme was to plan, shop and prepare their own meals. The level of staff support depended on the resident’s ability. Residents said they could choose what they wanted to cook. Two residents said that staff helped them to plan healthy meals and they joined in the healthy eating group. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20 Residents’ personal and healthcare needs were clearly identified and met by staff, with support from the multi-disciplinary team. Staff handled and administered medication in accordance with robust policies and procedures. However, the lack of assessments for residents who self medicate may result in risks not being identified or appropriately managed. EVIDENCE: None of the residents required physical assistance with personal care. Staff talked about prompting and supervising residents to ensure that their personal care needs were met and care plans contained information about the type and level of support they needed. There had been improvements in the way residents’ physical healthcare needs were recorded. All residents had a care plan with regard to health care checks or monitoring of ongoing physical health needs. Residents said that staff helped them to make doctors appointments and took them to hospital appointments if necessary. Several residents talked about their mental health care needs and the support they received from staff. One said “it’s nice here, the staff are great, they get you better when you’re not well.” Another said, “the staff are sound, they always ask if you’re alright and they are always there to support you.” There were very detailed care plans with regard to Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 14 mental health care needs. All residents had regular contact with other health and social care professionals. There was a full set of policies and procedures relating to medication. All residents had an individual medication procedure on their file, which outlined any special needs. Care plans contained a current list of medicines and information about effects and potential side effects for staff to monitor. Storage, administration procedures and disposal of medicines were appropriate. Residents who administered their own medication had very detailed plans but they must have an initial risk assessment as to their ability and safety to do so. There were a few gaps on medicine administration records (MAR) sheets and handwritten MAR sheets were not signed or witnessed. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Residents knew how to make a complaint and were confident that their concerns would be dealt with appropriately. Staff had a thorough understanding of adult protection issues ensuring that any allegations would be dealt with appropriately. EVIDENCE: A comprehensive complaints procedure was displayed on the notice board and all residents received a copy on admission to the home. Appropriate records were kept of any complaints, investigations and outcomes. There had been no complaints to the home or directly to the Commission in the last year. Residents named individual members of staff they would go to if they had any concerns. They were all confident that their complaints would be acted upon. One resident said he had “moaned” to staff about his flatmates not tidying up and they had sorted it out for him. Others said they had no complaints. One resident said “there’s not a bad thing to say.” Staff received training in the protection of vulnerable adults during their induction and were provided with updates. Appropriate guidelines and procedures for recognising and reporting abuse were available. All the staff spoken with understood protection issues and were clear about their roles and responsibilities in reporting allegations. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 and 30 Residents were satisfied with the furnishings in their bedrooms, which reflected their individual tastes. The standard of cleanliness and hygiene was satisfactory. EVIDENCE: Residents were satisfied with the furnishings in their rooms. One commented that their room was small but adequate. Others said that they had everything they needed. One resident said that they only had to ask if they needed anything and said that the registered person had bought him a new set of drawers because he had run out of space to put his clothes. Many of the rooms were personalised to a high degree and reflected the individual tastes of the resident. The home was clean and tidy at the time of the inspection. Residents were responsible for domestic tasks in their own flats. Staff monitored the standard and provided support where necessary. Residents said the system worked well and everyone usually did their share. Residents did their own laundry. Induction training for staff included hygiene and infection control and there were written guidelines for reference. Staff said they passed on basic hygiene and infection control guidance to residents as they worked with them. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34 and 35 Recruitment policies and practices provided safeguards for residents. Staff had access to a variety of training which increased their knowledge and understanding of the needs of the residents and assisted them to fulfil the responsibilities of their roles. EVIDENCE: Residents involved in the service user forum assisted with interviews of new staff. The files of two new employees demonstrated that appropriate preemployment checks were carried out. Staff started their induction training but did not have any contact with residents until a clear POVAfirst check had been received. Following the POVA check they worked under supervision until a satisfactory CRB disclosure was returned. Staff records should reflect that staff do not work with residents until the appropriate checks are obtained. Files contained the required documents. Residents were very complimentary about the staff. Their comments included “the staff are great,” “very friendly and helpful,” “brilliant.” There was an excellent induction and foundation training programme that exceeded the national training organisation specifications. The programmes comprised five topics and included a mix of guided reading, workshop attendance and 1:1 time with a mentor. There was an assessment of competency at the end of each topic. Experienced staff had been through the Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 18 programmes as refresher training. Staff said the training was very useful and comments included; “very organised,” “very thorough,” and “the mentors are very supportive and always available.” Staff also had access to a variety of inhouse and external courses relevant to the resident group. Staff said that training opportunities were “excellent” and said that they were encouraged to apply for any courses of interest. Residents said that they thought the staff were well trained. One said “the staff are very good, they know what they are doing.” Another said “staff are qualified, they always know what to do.” 18 of care staff were trained to NVQ level 2 or above. The management team discussed that a high proportion of the current NVQ syllabus did not equip staff to work with the residents at Almond Villas. Specific mental health units are due to be introduced in the near future and the uptake is expected to be higher at that stage. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40 and 42 Policies and procedures were up to date and safeguarded the rights and best interests of the residents. Health and safety training, practices and written procedures safeguard the health, safety and welfare of the residents and staff. EVIDENCE: There was a full set of policies and procedures that were reviewed annually. Following a recommendation from the previous inspection, a policy on physical interventions had been developed. Staff had clear guidance on managing aggression and de-escalation techniques. The service user forum was to be involved in developing policies in the future. Staff training in safe working practice topics was up to date. Recommendations from a recent visit from the fire officer had been actioned. The annual fire training should include some instruction on fire prevention. Regular fire drills were carried out. One resident said “we all have to do fire drills. Our times are really good now.” There was a full set of health and Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 20 safety policies, guidelines and risk assessments. Some potentially hazardous substances were stored in the laundry room and accessible to all residents. Risk assessments for these products must be reviewed whenever a new resident is admitted to the home or if there are any changes in residents’ individual risk assessments that indicate the potential for misuse. Maintenance and servicing of electrical and gas systems and other equipment was up to date. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x 3 x x x 3 Standard No 11 12 13 14 15 16 17 x 4 4 4 x 3 3 Standard No 31 32 33 34 35 36 Score x 2 x 3 4 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Almond Villas Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x 3 x 2 x F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 20 42 Regulation 13(2) 13(4)(a) Requirement Risk assessments must be carried out with residents who wish to self-medicate. Risk assessments must be carried out with regard to the storage of potentially hazardous items in parts of the home accessible to residents. The assessments must be updated as new residents enter the home. Timescale for action 31/08/05 30/09/05 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. Refer to Standard 6 Good Practice Recommendations Care plans should contain sufficiently detailed instructions for staff to ensure that the residents needs are met in a consistent manner. Care plans should be dated and signed by the member of staff involved in drawing them up. Handwritten MAR sheets should be signed and witnessed. 50 of care staff should be trained to NVQ level 2 by December 2005. Staff files should include evidence that staff are appropriately supervised whilst waiting for their CRB disclosure to be returned. F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 23 2. 3. 4. 20 32 34 Almond Villas 5. 42 Annual fire training should include some aspects of fire prevention. Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Almond Villas F57 F07 S5803 Almond Villas V230468 020805 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!