Inspection on 28/04/08 for April Cottage

This inspection was carried out on 28th April 2008.

CSCI found this care home to be providing an Adequate service.

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

April Cottage 23/04/07

April Cottage 12/10/05

April Cottage 21/06/05

April Cottage 25/11/04

April Cottage 07/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE April Cottage 1 Park Road Selsey Chichester West Sussex PO20 0PR Lead Inspector Ian Craig Key Unannounced Inspection 28th April 2008 11:15 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 April Cottage DS0000014364.V362559.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. April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service April Cottage Address 1 Park Road Selsey Chichester West Sussex PO20 0PR 01243 602450 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) Dr Hugh Charles Condon Dr Catherine Helen Condon Mrs Elaine Elizabeth Davitt Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd April 2007 Brief Description of the Service: April Cottage is a detached property situated in a quiet residential part of Selsey, within walking distance of local shops and the sea. There is a spacious garden surrounding the home and car parking space. The accommodation is arranged on two floors, comprising of two single bedrooms on the first floor and eighteen bedrooms on the ground floor. The first floor is accessible by stairs. Communal rooms comprise of a large lounge/dining room and a smaller lounge. The home is owned privately by Dr H and Dr C Condon and managed by Mrs E Davitt. The weekly fees range from £410.00 to £510.00. April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection was unannounced and lasted for four hours and 15 minutes. Information and evidence for the visit was obtained from the following: • A tour of the premises • Examination of records, documents, policies and procedures • Information contained in the Annual Quality Assurance Assessment completed by the home’s manager and returned to the Commission. • Discussions with 2 care staff and with the manager • Observations of care staff and residents • Discussions with 2 residents and shorter conversations with other residents • Survey forms completed by residents and professionals linked to the home • Records held by the Commission What the service does well: The home provides a relaxed and friendly environment for the residents and their visiting friends and family. Residents state that they are satisfied with the service provided. The following comments were made: • ‘It’s spotlessly clean.’ • ‘You couldn’t ask for more.’ • ‘The staff are helpful and kind.’ • ‘The matron is very helpful.’ • ‘You can choose what you want to do and where you want to go.’ • ‘Visitors can come when you want.’ The home has a staff member who is employed for two afternoons per week with the sole task of providing activities and stimulation for the residents. April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 6 There are effective working relationships with the district nursing service for those with specific health needs, which has resulted in the provision of specialist equipment. Staff attend a number of training courses. Newly appointed staff undergo the required checks such as the criminal record bureau check. The home is decorated and maintained to a good standard. What has improved since the last inspection? What they could do better: The system of assessing those referred for possible admission needs to improve to ensure that the home is able to meet the needs of those accommodated. Residents’ care and medication records need to be securely stored when not being used for reasons of confidentiality and privacy. Storage of medication needs to be reviewed so that it is secure and meets the recommendations of the Royal Pharmaceutical Society. Improvements are needed to ensure that each staff member has been trained to safely move and transfer residents. A security lock needs to be changed on a ground floor bathroom to a lock that allows staff access in an emergency. Improvements are needed to the system of instructing newly appointed staff so that there is a record of induction training. April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 7 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. April Cottage DS0000014364.V362559.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 April Cottage DS0000014364.V362559.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 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of detail regarding a recent admission of someone to the home has the potential to place residents at risk. EVIDENCE: The home has literature on the services provided by the home. These are supplied to potential residents, and their relatives, when considering a move into the home. Residents confirmed that they are received enough information about the home before they moved in and that they received a contract. April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 10 The process of assessing someone’s needs when they are referred for possible admission was looked at for two people. The manager explained that she visits prospective residents to assess his or her needs and suitability for the home. For one of the two people recently admitted there was a record of an assessment of need being completed on the same day the person was admitted. No written details had been received from the hospital discharging the resident to the home. For a second person, there was no record of any assessment of need although the manager stated that she had completed an assessment some days before the admission. No details had been entered in the home’s admissions book and there was no record of the person’s details such as date of birth. The only details were on a piece of paper with the telephone number of a relative and the resident’s age and birthday. Information had not been sought from any health professionals. April Cottage DS0000014364.V362559.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 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person has a care plan setting out how care needs are to be met. The home liaises with health care professionals to ensure that specialist health care needs are met. Residents’ privacy is not promoted by care and medication records being left in public places. EVIDENCE: Care plans were looked at for five residents. There is a score matrix assessment of need for each person, with the exception of one person. This is April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 12 updated each month. Each person has a care plan. There is a record made of significant events entitled, Observations to Help In the Planning of Care. Residents’ care records are not securely stored when not being used. Each resident has an allocated care staff member who takes the lead responsibility for coordinating care matters. The home liaises with the district nursing service so that residents are provided with specialist equipment such as pressure relieving mattresses. The home also uses the continence advisors from the local health care trust. The manager has experience of the care of those with a terminal illness. Staff were observed talking to residents in a kind manner and where needed they offered reassurance. Residents described the care they received as of a good standard and that their care needs are met. Care staff described the care routines, which acknowledges the choices for the people who live in the home for getting up and going to bed. Staff also confirmed that care is provided according to the assessed needs of the individual residents. Medication procedures were looked at. Staff sign a record each time medication is administered to a resident. Blister packs of medication show that medication is administered as prescribed. Controlled medication is administered as advised by the Royal Pharmaceutical Society guidelines. Storage of medication and the security of records needs to be reviewed and addressed. The door of the medication cupboard in the office does close fully when locked. The controlled medication cupboard is not fixed to the wall as advised by the Royal Pharmaceutical guidelines. Medications administration recording records are not locked away when not in use and medication records for two medicines administered to two people are displayed on the fridge door in the kitchen. Staff receive training in medication procedures from a local college. April Cottage DS0000014364.V362559.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a range of activities but there is scope to develop this further. People who use the service have choice in their daily lives. EVIDENCE: April Cottage employs a staff member for four hours a week (over two days) to take people out to the shops and places of interest as well as involving residents in other activities. A notice in the hall way indicated that there are ‘music for health’ afternoons once every six weeks. April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 14 A variety of books are available for the residents to read. Some of the residents have a daily newspaper delivered. There is entertainment for the residents, including a singing group who visit the home 3 or 4 times a year to entertain the people who live at the home. There is a carol-singing concert in the home at Christmas. Outings to local community groups and clubs take place and transport is arranged by the home. A priest visits the home regularly. A resident described how he is able to have visitors in his room at any time he wishes. A hairdresser visits the home on a regular basis. A mobile shop also comes to the home twice a year so that residents can buy items such as clothes. Residents report that there is a choice and freedom in the home, including food at meal times. Both the staff and the people who live at the home described the home as having a relaxed and informal routine, which the residents prefer. Individual care plans refer to each person’s preference as to how he or she wishes to spend his or her time. Comment was made by one resident that activities are ‘sometimes’ provided, indicating that this could be improved. Records of food are maintained showing that individual preferences are catered for. Residents have different food for breakfast, lunch and the early evening meal. Each person is asked what he or she would like to eat for the early evening meal, which is recorded. A varied and nutritious diet is provided. Fresh fruit is available. Residents were observed eating the midday meal. Staff assist people with eating where is was needed. Arrangements were made to cater for a resident’s sudden change of mind about the food she preferred. April Cottage DS0000014364.V362559.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. The home ensures that residents and their relatives have access to the complaints procedure reflecting ‘openness’ to improving the service. Steps are taken to protect residents from possible abuse. EVIDENCE: The home’s complaints procedure is displayed in the home and is supplied to each resident in the home’s Statement of Purpose and Service Users’ Guide. Residents confirmed that they are aware of the complaints procedure and whom they should speak to if there is something they are not happy with. The home has a procedure for dealing with any suspected abuse. Staff are trained in the procedure by the manager. This was evidenced from discussions with the manager and with the staff as well as from training records. The home has liaised with relevant health and social care agencies regarding any matters affecting the welfare of the residents. April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 16 Each care staff member is subject to Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. April Cottage DS0000014364.V362559.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, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a clean and well maintained environment. EVIDENCE: The home has made a number of improvements to its interior since the last inspection. A capital grant from the government has been used for the redecoration and recarpeting of the lounge and the installation of a wide screen LCD television. The grant has also been used to purchase a computer for the residents to use. At the time of the visit this was still being installed April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 18 and the manager confirmed that the computer will have internet access. Garden furniture has also been purchased. There is a second lounge, which is referred to as the ‘quiet lounge’ where residents can take visitors. A tour of the home showed it to be clean and decorated to a good standard. There are no odours. Residents commented that, ‘It is spotlessly clean.’ Bedrooms contain a number of personal possessions belonging to each resident. This includes television, radio, ornaments and pictures as well as more personal items such as photograph displays. Residents are also encouraged to bring their own furniture to make their bedroom more personal and homely. Several residents have had their own telephone line installed in their bedroom. A number of residents described how they liked their room and the views across to the adjacent paddock, which has a number of horses. All bedrooms are single and are on the ground floor with the exception of two rooms on the first floor, which were unoccupied at the time of the inspection. These 2 rooms do not have assisted access by stairlift and would require that any occupant is fully mobile. Six bedrooms have an en suite toilet and all bedrooms are single. Each bedroom has a lock and residents are able to have a key to their bedroom door if they wish. The bathrooms were found to be clean and have been recently redecorated. Soap dispensers and paper towels are provided. It was noted that a lock on one of the bathroom doors is of a type that does not allow staff access in an emergency should they need to get to a resident. The home has gardens, which the residents can use and access is aided by ramps for those with mobility needs. There is a laundry and 9 staff members have completed infection control training. April Cottage DS0000014364.V362559.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a staff team supplied in sufficient numbers to meet their needs. The home’s recruitment procedures protect the residents. Improvements are needed to the system of training newly appointed staff as the current procedures do not ensure that staff are competent in care tasks. EVIDENCE: The home aims to provide at least two care staff on duty from 8am to 8pm each day. The manager’s working hours are additional to this. This was confirmed from discussions with the manager and the staff, observation, and from the staff rota. A cook works from 9am to 2pm each day of the week and a cleaner is employed for between 3.5 and 4.5 hours for 5 days of the week. Younger staff April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 20 are employed to help with the serving of food for a limited number of hours per week. This has been done by involving the local authority education department so that procedures meet current employment law. A member of staff is employed for 2 periods of 2 hours per week with the responsibility of arranging activities for the residents. Recruitment procedures were checked for 3 recently appointed staff. Each person is subject to Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks before they start work. Two written references are also obtained. Prospective staff are interviewed. The manager states that newly appointed staff have an induction so that they are instructed in how to competently carry out their care tasks. There is no record to show that the staff have received an induction or have been assessed as competent to complete care work. It was also noted that one of the newly appointed staff has not received training in moving and handling from a qualified trainer. This person is involved in the moving and handling of residents. Records show that staff have supervision and an annual appraisal. This was also confirmed from staff. Training records and discussions with staff show that the following training has been provided: the protection of vulnerable adults, food hygiene, infection control, health and safety, safe handling of medicines, nutrition, first aid and fire safety. 45 of the care staff are trained, or are completing the training, to National Vocational Qualification in Care level 2 or above. The national minimum standard is that 50 of staff are trained to this level. April Cottage DS0000014364.V362559.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, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs to improve the process of assessing those people referred for admission and for training newly appointed staff to ensure the care and safety of the people who live at the home. EVIDENCE: The manager has been at April Cottage for 18 years, having previously been a manager at another home. Mrs Davitt is a qualified nurse although she is not April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 22 employed in this capacity at April Cottage. Mrs Davitt has undertaken training in falls prevention and has updated herself in mandatory areas such as food hygiene. She is also a qualified NVQ assessor. The manager seeks the views of relatives, residents and other people connected to the home such as the doctors and district nurses. The results of these surveys are compiled into a pie chart. The home does not carry out an annual audit. The registered owners complete a monthly report on the home. The home has an annual business plan. The monthly reports and the business plan are very brief and do not give enough information about what has been assessed and future plans for the home. The home occasionally looks after the finances of individual people who live at the home. There is a residents’ bank account, which accrues interest for the residents’ money. Records are kept of any monies, which are held for safekeeping. Records of residents’ medication and care plans are not securely stored when not being used. Staff are trained in first aid, infection control, moving and handling and food hygiene. One staff member is involved in the moving and handling of residents without receiving the required training. Each resident has a risk assessment for possible falls, mobility and transfer. The manager explained that staff are to receive first aid ‘update’ training. Radiators are covered to prevent residents’ receiving possible burns. Temperature controls are installed on hot water outlets to prevent possible scalds to residents from immersion in baths. The home’s appliances and equipment are tested and serviced by suitably qualified persons. The fire log book shows that the fire safety equipment is tested in accordance with fire safety regulations. Staff receive training in fire safety and fire drills take place. April Cottage DS0000014364.V362559.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 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 2 2 April Cottage DS0000014364.V362559.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 OP3 Regulation 14 Requirement New residents must only be admitted following a full assessment by people trained to do so and after liaison with any relevant professionals, which confirms the suitability of the person to live at the home. These assessments must be in writing. 2 OP9 13(2) 28/06/08 The home must review its storage of medication to ensure it is secure. This includes the medication cupboard in the office and the storage of controlled medication. The storage of controlled medication must include: • Metal cupboard of specified gauge • Specified double locking mechanism • Fixed to a solid wall or a wall that has a steel plate mounted behind it • Fixed with either Rawl or Rag bolts. April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 25 Timescale for action 28/05/08 3 OP21 12(4)(a) Privacy locks on toilets, bathrooms and bedroom doors must permit staff access in an emergency. Newly appointed staff must receive an induction and be assessed as competent. This must be recorded. Residents’ care and medication records must be securely stored in the home. 28/06/08 4 OP30 18(a)(c) 28/06/08 5 OP37 17(1)(b) 28/05/08 6 OP38 13(4)(5) Staff who are involved in the 28/07/08 moving and handling of residents must receive training from a trainer who is qualified in moving and handling training. 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 April Cottage DS0000014364.V362559.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI April Cottage DS0000014364.V362559.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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