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Inspection on 24/07/07 for Ashby Court Nursing Home

Also see our care home review for Ashby Court Nursing Home for more information

This inspection was carried out on 24th July 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Assessment and care planning policies and procedures were comprehensive and ensured that residents needs and preferences were met. Daily activities and routines were flexible in order to meet resident`s needs. Residents praised the staff employed, comments included -: `Staff are always very friendly and welcoming`. `All the staff are absolutely superb, wonderful`. Residents also praised the quality of meals provided and the range of activities on offer. A great deal of care and attention is put into ensuring that meals provided are nutritionally balanced and a varied and appealing range of meals are available. At the time of this inspection all areas of the home seen were clean and hygienic. The home was decorated and furnished to a high standard and provided a comfortable and homely environment. The home was well run and managed by an experienced manager. Staff were given the training and support required to do their jobs. A comprehensive system of quality assurance assessments were in place in order to ensure that day to day care practices and procedures adhered to policy and met the expectations of residents accommodated.

What has improved since the last inspection?

A new system of needs assessment and care planning has been introduced. Dementia care training was being provided to staff.

What the care home could do better:

A recommendation was made that safeguarding adults training should be given to all staff who come into contact with residents and not just to nursing and care staff. The company regional support manager said that this training was planned to take place later in the year.

CARE HOMES FOR OLDER PEOPLE Ashby Court Nursing Home Tamworth Road Ashby de la Zouch Leicestershire LE65 2PX Lead Inspector Debbie Williams Unannounced Inspection 10:00 24 of July 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 Ashby Court Nursing Home DS0000001884.V340361.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. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashby Court Nursing Home Address Tamworth Road Ashby de la Zouch Leicestershire LE65 2PX 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) 01530 560105 01530 560173 coalesr@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited Mrs Ruth Coales Care Home 60 Category(ies) of Dementia - (60), Old age, not falling within any registration, with number other category (60), Physical disability (60) of places Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission are within the following category: Old age, not including any other category (OP) 60. Physical disability - (PD) 60. Dementia (DE) 60. The maximum number of persons to be accommodated at Ashby Court nursing home is 60. 2. 3. 4. Date of last inspection 14th November 2006 Brief Description of the Service: Ashby Court is a care home providing nursing care for up to 60 older people. The home is situated on the outskirts of Ashby in a residential area and is purpose built. It is easily accessed by public transport. The home provides residential and nursing care for sixty service users whose care needs fall within the categories of Older Persons and or Physical Disability over 65 years of age and terminal illness over 65 years of age. Accommodation is on two floors and can be accessed via a passenger lift. There is a choice of lounge/dining areas and all private rooms are with en suite facilities. The ground floor has spacious lounge and dining areas and the dining room opens out into the patio, which has been developed by the staff to include a herb and sensory garden. The home has fifty-four single bedrooms and three double bedrooms. All of the bedrooms are en-suite. The home employs registered nurses and care staff. Close to the home is a large shopping centre and a number of pubs and restaurants. At the time of this inspection the weekly fees ranged from £595 to £695. A copy of the last inspection report was available at the home. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and was facilitated by the company regional support manager. At the time of this inspection the providers had recently changed their categories of registration in order to accommodate residents with dementia. A separate unit on the first floor was being developed for this purpose. The focus of inspections is upon outcomes for residents living at the home and obtaining their views of the service provided. The main method of inspection used was ‘case tracking’ which meant selecting four residents and tracking the quality of their care by checking records, discussion with them, discussion with visitors to the home and with staff. The inspector spoke with two residents’ three staff members and one visitor. Information provided within the provider’s annual quality assurance assessment was also used to gather evidence for this inspection. This was a positive inspection, good outcomes were achieved in all areas and an excellent outcome was achieved in one area. What the service does well: Assessment and care planning policies and procedures were comprehensive and ensured that residents needs and preferences were met. Daily activities and routines were flexible in order to meet resident’s needs. Residents praised the staff employed, comments included -: ‘Staff are always very friendly and welcoming’. ‘All the staff are absolutely superb, wonderful’. Residents also praised the quality of meals provided and the range of activities on offer. A great deal of care and attention is put into ensuring that meals provided are nutritionally balanced and a varied and appealing range of meals are available. At the time of this inspection all areas of the home seen were clean and hygienic. The home was decorated and furnished to a high standard and provided a comfortable and homely environment. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 6 The home was well run and managed by an experienced manager. Staff were given the training and support required to do their jobs. A comprehensive system of quality assurance assessments were in place in order to ensure that day to day care practices and procedures adhered to policy and met the expectations of residents accommodated. 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. The summary of this inspection report can be made available in other formats on request. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 (standard 6 is not applicable to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process was thorough and ensured that residents needs are assessed and met. EVIDENCE: A new system of assessment and care planning was being used. Assessment records seen were thorough and identified care needs and care plans required, it was evident that residents and or their families had some involvement in the Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 9 assessment and care planning process. Risk assessments were also undertaken for each individual resident. Information provided within the providers quality assurance assessment stated that ‘All prospective residents undergo a pre-admission assessment to ensure the home can meet any identified need and that the placement will be appropriate. Comprehensive information booklets are provided for new residents entering the home, helping them to understand all the issues on moving into a care home. Residents and relatives spoken with confirmed that information about the service had been provided before moving into the home and that a needs assessment had taken place. Relatives spoken with had been able to personalise their relative’s room with pictures and photographs and some pieces of furniture prior to them moving in. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning and procedures in place meet resident’s needs and minimise risk. EVIDENCE: Care records for four case tracked residents were inspected. A new system of care planning has been introduced, this documentation is known as ‘Quest’ A comprehensive assessment is carried out and this identifies clearly all care plans required. Evidence of residents and or family involvement in the care planning process was seen. Care plans were reviewed at least monthly. Care plans seen appeared to meet the assessed needs for case tracked residents spoken with. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 11 Risk assessments were `also in place, each resident had an individual fire risk assessment which stated the method of evacuation required in the event of a fire. Malnutrition, fall and pressure sore risk assessments were also in place. A map of life was in place for one case tracked resident and this provided an overview of significant life events. An activity profile was also in place setting out social and recreational preferences and needs. An advanced care plan was in place for one resident regarding end stage of life. The providers were planning to introduce Liverpool care pathways to use for residents requiring terminal care; these are considered best practice with regards to terminal care. Records of GP visits and hospital appointments were seen within individual care records. The home provides nursing care and therefore there are always qualified nurses on duty. One qualified nurse spoken with said that further specific clinical training had been provided since her employment at the home. Medication administration records and storage areas were seen. Medication records appeared accurate and in good order. Medication training is provided ‘in house’; staff are assessed prior to administering medication unsupervised. Staff spoken with confirmed they were aware of medication policies and procedures. Each resident had a care plan in place for the medication they were prescribed. Residents and relatives spoken with felt that staff were very friendly and respectful. Residents felt that staff maintained their privacy and dignity. Interactions observed between staff and residents appeared positive and respectful. The following information was provided within the providers annual quality assessment -: All residents have comprehensive personal care plans individual to their identifeid needs. We have a comprehensive suite of policies and procedures and the Royal Marsden manual of policies and procedure. There are company specialists both regionally and Nationally who can be consulted for advice and support at any time. Any pressure ulcers are recorded. the information is collated within BUPA Care Homes and the information is used to identify trends and inform the purchase of appropriate equipment. All residents have a nutritional screen using the MUST nutritional screening Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 12 tool. Every resident is registered with a General Practitioner. The recently updated medication policy meets the criteria of the National Minimum Standards and the guidance from the Nursing and Midwifery Council and the Royal Pharmaceutical Society Medication management is regularly audited , using an external Pharmacist Privacy and dignity feature highly in BUPA Care Homes customer service programme Personal Best. Working towards Gold Standard Framework, the Liverpool Care Pathway and the Dale project Ashby Court Nursing Home DS0000001884.V340361.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): Standards 12,13,14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Daily life and social activities meet resident’s needs and preferences. Meals provided are of a very good quality. EVIDENCE: Residents spoken with said that routines of daily living were made flexible and they were enabled to maintain independence, choice and autonomy. Visitors were made welcome at the home and could visit at any time; relatives spoken with also confirmed this. A full time activities organiser is employed. The activities board in the main reception area listed a range of activities on offer including trips out. One resident spoken with was aware of the activities on offer and said she was often given the opportunity to attend the trips out. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 14 Residents, relatives and staff spoken with praised the quality of meals provided. The chef has been employed at the home for twelve years and has consistently demonstrated a high level of commitment, enthusiasm and talent. At the time of this inspection a ‘virtual culinary cruise’ was an ongoing weekly event, each week a menu from a different country was provided and the dining room decorated accordingly. The dining room was decorated with international flags and with a cruise liner theme. Menu records were seen and appeared to be providing a varied, wholesome and nutritious diet. A nutritional assessment tool is used and this is applied to each new menu, the menu is only agreed to if the nutritional score meets the required total, this ensures that the menu is nutritionally balanced. The full menu with alternatives is displayed. There is also a ‘night bite’ menu, which is also in a pictorial format, a good range of light meals, and snacks are available at anytime. The chef makes a point of speaking with residents on a daily basis; residents and relatives spoken with confirmed this. There were no specific cultural or religious meals being provided at the time of this inspection. Diabetic, gluten free, high protein, soft and pureed diets were being provided. The following information was provided within the providers annual quality assessment audit ‘We offer an activity programme regularly assessed and updated The home has an open visiting policy taking into account residents wishes. Residents may handle their own finances if they wish to do so. We encourage the personalisation of residents individual space with their personal belongings. A full and varied menu is available in the home. The BUPA Menu master helps us to ensure the menu meets the nutritional needs of the residents. We do themed parties ie. A Virtual world cruise where we visit a different country each week and offer a suitable menu from that region and we decorate the dining room appropriately. A 1940s party to celebrate BUPAs 60th birthday with a typical menu of spam fritters, egg sandwiches, jelly and blanchmange and ginger beer, tizer and dandelion and burdock. Fancy dress optional. A trip down memory lane. We have printed a book of residents memories as part of the Living History project sponsored by BUPA’. Ashby Court Nursing Home DS0000001884.V340361.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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures in place minimise risk and offer protection to residents. EVIDENCE: The complaints procedure is displayed in the reception area. One resident spoken with felt they could make a complaint to any staff member should they need to. A record of all complaints received is maintained and complaints are responded to and action taken recorded. All care and nursing staff spoken with had received safeguarding adults training. Domestic staff had not received safeguarding training, the area support manager said there were plans to introduce this to all staff members. There were clear policies and procedures in place for dealing with complaints and safeguarding issues, staff were aware of and adhered to these policies. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained and comfortable environment. EVIDENCE: All areas of the home seen appeared clean and hygienic and were furnished and decorated in a homely way to a high standard. Resident’s rooms were personalised. One resident spoken with said their family had been able to get their room ready (bring in pieces of furniture and hang pictures) for them before they moved in to the home. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 17 Staff spoken with had received infection control training and were aware of the correct policies and procedures. The following information was provided within the providers annual quality assessment audit – ‘We provide a clean and well maintained environment with facilities that meet the needs of the service user. We use a specialist microfibre cleaning system that combined with effective regimes keeps the home clean and odour free. Our comprehensive policies and procedures include control of infection and handling clinical waste. Services and facilities comply with the water supply (water fittings) regualtions The home is supported in maintaining the environment by a central team of experts within BUPA Care Homes. We have a specialist property and estates department as well as a hotel services department’. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for and protected by competent staff and thorough recruitment procedures. EVIDENCE: At the time of this inspection there were forty-eight residents living in the home. The home was staffed with two qualified nurses at all times plus nine carers in the morning, seven in the afternoon/evening and three at night, the manager and deputy manager are supernumerary. Staff and residents spoken with felt that there were enough staff on duty and they were only occasionally left short of staff due to last minute sickness etc. Staffing levels were calculated according to resident’s dependency levels. There were nine care staff with a national vocational qualification in care and six working towards this qualification. The regional support manager said that the company aimed to get all care staff registered to do this qualification. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 19 Staff files were seen for two staff members and these contained all relevant checks and references. Training certificates and the staff-training matrix was also seen. Staff spoken with described the training they had received and felt they had received the training and support required to do their jobs. Dementia care and challenging behaviour training was being provided to staff in preparation for them working in the new dementia care unit. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,35,36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well run and in the best interests of residents. The health, safety and welfare of residents and staff are promoted by policies and procedures in place. EVIDENCE: The registered manager is a qualified nurse and has extensive management experience. Residents and staff spoken with felt the management approach Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 21 was open and inclusive. Regular staff and resident meeting were held, minutes of these were seen. The providers have achieved the Investors in people award. A comprehensive system of audits was in progress that enabled senior management to monitor the quality of the service. Accident records were maintained and audited. A three monthly health and safety meeting takes place and the minutes of these are reviewed by the company health and safety team. Staff spoken with confirmed that regular supervision and appraisal was provided. The following information was provided within the provider’s annual quality audit assessment – ‘The manager ensures the health and Safety and welfare of all service users and staff, and that the nursing home promotes a positive atmosphere. There are regional and national experts available within the company for advice and guidance if required. There are dedicated health and Safety staff within the Quality and Complinace directorate. BUPA Care Homes has a comprehensive suite of policies and procedure manuals that are regularly reviewed by experts and updated as required. BUPA Care Homes has an annual customer satisfaction survey. The provider’s annual quality audit system also confirmed that all necessary maintenance checks and procedures had been carried out. Records seen confirmed that staff had received all relevant health and safety training. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. OP18 Refer to Standard Good Practice Recommendations It is recommended that all staff that have contact with residents receive safeguarding adults training. Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 Page 24 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 Ashby Court Nursing Home DS0000001884.V340361.R01.S.doc Version 5.2 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. 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