Inspection on 07/06/05 for Baldock Core & Cluster

This inspection was carried out on 7th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Baldock Core & Cluster 15/11/06

Baldock Core & Cluster 14/11/05

Baldock Core & Cluster 07/12/04

Baldock Core & Cluster 28/07/04

Similar services:

Claremont House

Chesham House

Argyll House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

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

CARE HOME ADULTS 18-65 Baldock Core and Cluster 17/18 Coach House Cloisters 10 Hitchin Street Baldock, Herts SG7 6AL Lead Inspector Alison Butler Unannounced 7 & 10 June 2005 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. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Baldock Core and Cluster Address 17/18 Coach House Cloisters, 10 Hitchin Street, Baldock, Herts, SG7 6AL 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) 01462 490016 01223 576750 Granta Housing Society Limited Vacant CRH Care Home 30 Category(ies) of LD-30, LD(E)-30, PD-30, PD(E)-30 registration, with number of places Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. This cluster may also accommodate people with physical disability (when associated with a learning disability) aged from 18 years. Date of last inspection 7 December 2004 Brief Description of the Service: The scheme consists of six houses in Baldock, five of which are detached properties and one is a semi-detached property.All are within easy walking distance of local ameneties. All offer single rooms and some have assisted bathrooms. Each house has a full range of domestic facilities. New Farm has seven bedrooms, 2b Icknield Way has three bedrooms, 12 North Road has five bedrooms, 7 Clothall Road has six bedrooms, 15 Clothall Road has four bedrooms, The Rowans has five bedrooms. The aims of the scheme are to assist service users to explore faciltlies and intergrate them into the local community and to provide an environment for service users to learn, maintain and enhance their capabillties to their limit and in accordance with their wishes. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days, as the inspectors were unable to access all the homes due to the residents being out. Not all the records could be accessed on the first visit, as the acting assistant manager was unable to do this. The inspectors checked on the requirements and recommendations that had been made at the previous inspections. A number of records were also inspected. All residents and staff within the scheme were spoken to. What the service does well: What has improved since the last inspection? What they could do better: The redecoration programme could do with being speeded up as progress is extremely slow. It can be disruptive to the staff and residents as the work is being carried out by the probation service they are only available one day a week. Requirements that had been issued at the last inspection remain unmet with regard to the decorating of the hall and office at No. 7. An extension to this requirement has been agreed as the work had commenced the week of the inspection. An enforcement notice has been issued to ensure the decoration of the kitchens at North Road and the Rowans is brought up to an acceptable as Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 6 this remains outstanding even though an extension was agreed on the previous requirement deadline. The procedure for controlled drugs needs to be revisited to ensure staff are fully compliant as they were unable to be reconciled and it appeared that one dose was missing. The service users guide should be made into a user-friendly version and should be individualised for each of the homes detailing the provision and support each provides. Dishwashers must be provided in the homes where they are not in place, as the hot water in the kitchens does not reach the required temperature of 60 degrees Centigrade in line with the health & hygiene regulations for the destruction of bacteria. Staff also confirmed they were having to boil the kettle to provide adequate hot water and this is a risk in itself. There was no hot water in the kitchen at No15 on the day of the inspection and an immediate requirement was issued to ensure this was acted upon. 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. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 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 Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 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) 1 & 3 Residents and/or their families receive information about the service, which enables them to make a choice about whether or not, they may wish to live in the home. The home is able to meet the needs of the residents. EVIDENCE: Although a Statement of Purpose and Service User guide are available these documents must be reviewed and amended to reflect the proposed variation of category and staffing requirements. The recommendation that has been made at previous inspection to produce the service users guide into a user-friendly format for the residents and to individualise them for each of the homes within the scheme remains. Although the home appear to be meeting the needs of the individual service user who is out of category. The proprietor must apply for a variation to the registration to allow him to stay and put forward a plan on how to manage and support the resident and staff should his mental health needs change. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 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, 7, 8, 9, & 10 Resident’s needs are assessed and any goals are reflected within their care plans. Although not all of them are as detailed as they could be. Support and advice is given to residents to help them make decisions about all aspects of their lives. All information is handled appropriately and confidentially. EVIDENCE: All service users have an individual plan and are allocated a keyworker to support them in their lives and choices. It is noted that the new care plan approach that was introduced last year had been well received although it is now evident that a review should be carried out to eliminate the amount of repetition it creates. The care plans examined showed that although some were well documented some work needs to be done on some ensuring that they are more detail in the action required by staff in meeting the individual needs. Residents are supported and encouraged to take part in daily tasks including shopping, meal preparation and cleaning. Risk assessments are in place for residents and it is recommended that these be cross-referenced from the care plan detailing where they can be found (The Rowans). All information is held appropriately within the homes. Staff are aware of the need for confidentiality and this is covered as part of the induction process. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 10 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 Residents are able to choose which activities to take part in the local community. They are able to engage in appropriate leisure activities. EVIDENCE: To establish all the residents needs can be quite difficult due to their complex needs. Some are able to show their feelings and wishes by facial expression and appeared happy when asked about their lives. Some residents were watching television or listening to music. One resident talked about his holiday in which he was due to go later in the week with the other residents living in the home. Holidays have been booked and some had already been taken, some residents choose day trips as an alternative to actually going away on holiday. Residents have a daily programme in place for attending day centres and or college. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 11 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 &20 Residents are able to receive personal support in the way they prefer, with the constraints of health & safety of themselves and staff. Health care needs are recorded within their care plans. Policies and procedures are in place to ensure that they have their medication administered appropriately although this had not been the case in North Road. EVIDENCE: Each resident has a plan in place and where possible a female carer deals with the personal care for female residents. The staff are knowledgeable about the residents needs and how these need to be met. Following a visit to the GP, dentist, Chiropodist or other health professional, these visits are recorded on their files with details of any further treatment or follow ups required. On examination of the medication in all but one house, on the whole they were well kept (with the exception of New Farm which showed gaps in the administration sheet for one resident). This medication was no longer in the dosette box. At North Road the inspector was also unable to reconcile the controlled drugs even with using the medication, administration record sheet and a separate recording book. There still appeared to be a missing dose. A requirement has been made for an audit to be carried out and a report forwarded to the Commission For Social Care Inspection. Staff should be reminded to carry out checks as per the medication and handover policies and procedures to ensure this doesn’t happen in the future. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 12 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 &23 Views of residents are listened to and acted on. Policies and procedures are in place to protect residents from abuse, neglect and self-harm. EVIDENCE: The Hertfordshire County Council Adults at Risk procedure is on display and staff confirmed they were aware of the whistleblowing procedure; this is also covered within the induction programme. Staff confirmed they had not received complaint since the last inspection. Protection of vulnerable adults training is provided within Grantas’ on-going training programme. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 13 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) 24, 25, 26, 27, 28, 29 & 30 The scheme is in need of some redecoration and works to ensure it functions as a homely, comfortable and safe environment for the residents. Individual bedrooms with the exception of one were individualised, decorated and provided appropriate furniture to meet the resident’s needs. EVIDENCE: It was disappointing to note that although the two kitchens within the scheme had been replaced they had not yet been decorated. This does not provide a homely environment especially for the residents at North Road who also take their meals within the kitchen/dining area of the home. An enforcement notice is being considered. The decoration of the office and hallway at No 7 has commenced but as the work is being carried out by the Probation Service, this is a long process and they appear to only been within the scheme one day a week. Staff stated this could be disruptive, as staff need to be around when they are present in the home. The kitchen in No 7 is need of repair or renewal as some of the unit doors are chipped and/or damaged. The flooring around the edge has a gap allowing dirt to congeal making it look unsightly and a possible breeding place for bacteria. The staff are in the process of looking at additional en-suite facilities being provided in the ground floor bedroom to Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 14 meet the changing needs of the individual resident. The main bathroom in New Farm is also in need of redecoration and the bath must be re-enamelled or replaced to bring it up to an acceptable standard. The fridge must be replaced as it has parts that are being held together with tape and the seal is also coming away from the door. The requirement left at the last inspection for the resident’s bedroom has been decorated although he has yet to have new furniture purchased this requirement has been brought forward. All the homes were cleaned to a high standard. One room in No 15 had a strong odour the staff need to ensure they monitor the situation and possibly look at alternative flooring. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 15 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) 31, 32 , 33 & 34 The home is suitably staffed with well trained individuals ensuring that at all times the service users changing needs can be met. All the required information on staff files must be held on site and be available to ensure that the protection and safety of the residents is protected at all times. EVIDENCE: Staff are clear as to their roles and responsibilities. All staff have received a copy of the General Social Care Council Code of Conduct. Job descriptions and person specifications are held with the policies and procedure folders held at the scheme. There is an on-going training programme in place and a new matrix has been put in place since the last inspection giving the name of each member of staff then listing training complete and training booked. Personal records inspected showed that a member of the bank staff not all the required information was available for inspection. The organisation must ensure that all the required information is forwarded to the scheme and be available for inspection at all times. The appraisal process has commenced within the scheme. The supervision of staff will be examined at the next inspection. Staff feel they are supported and regular meetings take place for both the house managers and the individual teams. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 16 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) 37, 38, 39, 41 & 42 The management within the home is effective through the appointment of an acting manager; there are two assistant managers one who is acting up on a temporary basis and due to leave the project in the near future. Quality assurance systems are in place to ensure that the resident’s views underpin all self-monitoring, review and development of the scheme. The health, safety and welfare of everyone living, working or visiting the scheme is promoted through a series of checks. The hot water within the kitchens of the homes raises some concerns. EVIDENCE: There has been no registered manager in post since January 2005; the assistant manager has taken on the role to ensure the smooth running of the scheme. There is two assistant managers one of whom was brought in from another scheme within Granta but whom is due to leave the scheme in the near future to take up a new post nearer to home. The staff informed the inspector that the newly appointed manager had visited the scheme this week Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 17 but they were unsure of the start date. Observation between staff and the residents was seen to offer appropriate support and encouragement. An internal quality assurance audit has been carried out and the inspector was provided with a copy of the report this also included an action plan. Regular meetings are held and minutes taken. All records are secured appropriately. Fire records examined were up to date with a Full Fire Service inspection having taken place on 21st April 2005. Risk Assessments had been completed with the exception of one for a resident who likes to look at how electrical equipment works. A requirement has been made. The inspector has concerns that the dishwashers have still not been provided and the water in the kitchens only reaches a maximum of 45 degrees Celsius and therefore not hot enough to destroy bacteria. Staff confirmed that they boil the kettle to provide hot water in which to wash the crockery after meals, the inspector felt this created a further risk to both residents and staff from possible scalds and burns. In 15 Clothall Road no hot water although it would only reach a maximum 43 degrees was available in the kitchen on the day of the inspection and an immediate requirement was issued to have this rectified. The radiator in the toilet at the Rowans has been turned off to prevent scalding and/or burning to the residents and notice has been put in place to remind staff that it must remain off at all times. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 18 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 2 x 2 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 2 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x x Standard No 31 32 33 34 35 36 Score 3 3 3 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Baldock Core and Cluster Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x 3 2 x I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 19 yes 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. Standard 20 Regulation 13(2) Requirement The manager must ensure that the correct procedure is followed for the recording and checking of controlled drugs at North Road. The proprietor must ensure the kitchens in North Road & The Rowans must be decorated and brought up to an acceptable standard. A notice has been issued. The proprietor must ensure that the kitchen units and flooring(No. 7) must be repaired or replaced and brought up to an acceptable standard The proprietor must ensure that the hall and office in No. 7 are decorated and brought up to a reasonable standard. This has been brought forward from the previous inspection and a new timescale set. The proprietor must replace the furniture in consultation with the service user (New Farm) This has been brought forward from the previous inspection and a newtimes scale set. The proprietor must replace the fridge (New Farm) to ensure the Timescale for action immediate as of 7th June 2005 and Henceforth by 28th July 2005 2. 24 23(2)(b) & (d) 3. 24 23(2)(b) & (d) by 30th September 2005 by 31st July 2005 4. 24 23(2)(d) 5. 24 16(2) (c) by 30th September 2005 6. 24 16(2)(g) by 30th June 2005 Page 20 Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 effective storage of chilled food. 7. 27 23(2)(b) & (d) The proprietor must ensure that the bathroom (New Farm) is decorated and the bath reenamelled or replaced and brought up to an accetable standard The proprietor must ensure all required information on staff employed by the home is available at all times for inspection. The proprietor must ensure that hot water is available at all times by 30th September 2005 8. 34 9. 42 17(2) schedule 4 (6) & 19 (1) schedule 2 23 (2) (c) immediate as of 10th June 2005 and Henceforth immediate as of 10th June 2005 and henceforth by 30th September 2005 immediate as of 7th June and henceforth. by 30th June 2005 10. 11. 42 42 13 (3)& 13 (4)(a) 13 (4) (b) & (c) 5.24 Care Standards Act 2000 12. 3 The proprietor must install dishwashers to prevent the spread of infection. The proprietor must ensure a risk assessemnt is completed for the service user who chooses to dismantle electrical equipment The proprietor must complete a variation application to the service user who was admitted out of category. 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 1 Good Practice Recommendations The proprietor should establish a way of creating the Service User Guide into a user-friendly format. This has been brought forward from the previous inspections. The Service Users Guide should be indivdiualised for each home as they eavch provide different support faciltiies. This has been brought forward from the previous inspections. I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 21 2. 1 Baldock Core and Cluster 3. 4. 5. 6 6 20 A review should be carried out on the new care plan format to reduce the amount of repetition. The propritor should ensure that all care plans give full details required by staff on how to meet the needs of the individuals. The proprietor should ensure that staff are clear of the policies and procedures of the medication and handovers to eliminate errors in medication. Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ 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 Baldock Core and Cluster I52 s19278 Baldock Core & Cluster v231479 070605 Stage 4.doc Version 1.30 Page 23 - 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. 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