Inspection on 08/02/06 for Beatrice Road, 36

This inspection was carried out on 8th February 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beatrice Road, 36 09/08/07

Beatrice Road, 36 09/11/06

Beatrice Road, 36 09/08/05

Beatrice Road, 36 08/02/05

Beatrice Road, 36 29/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Beatrice Road, 36 London SE1 5BT Lead Inspector Barbara Ryan Unannounced Inspection 8th February 2006 10:00 Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 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 Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 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 Adults 18-65. 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. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beatrice Road, 36 Address London SE1 5BT 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) 020 7252 0302 jo.morgan@choicesupport.org.uk Choice Support Mr Keshorsingh Beegun Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9 August 2005 Brief Description of the Resident : The home is of bungalow design registered to provide accommodation and high support care for 3 men with learning disabilities. It is one of a number of homes operated by Choice Support Southwark, which provides staffing and daily operational support services. The building is owned and maintained by Habinteg Housing Association. The property is similar in designed to others on the same side of the street and was purpose build to provide accommodation for people with disabilities. It is located in a residential street in south east London, close to shops, banks social, leisure facilities and public transport. The home offers 3 single bedrooms, a lounge, dining area, kitchen, wc /laundry room, bath, shower room and a back garden. There is an additional room that is used as an office/staff room The home provides waking night staff. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 8 February 2006. All three residents were at home and were seen and spoken to. There was a tour of the building and garden. One staff member was spoken to and the service manger spoken to by phone The manager was on 4 weeks leave, the person acting as manager in their absence was also was leave. There was a telephone conversation with the service manager and subsequent telephone call later in the week. What the service does well: What has improved since the last inspection? The home now has a land line phone, and photo copier/fax. The home have continued to work with historical issues arising from how the home was first set up and issues around tenancies and residents benefits entitlement. Whilst these are still to some extent unresolved the home are continuing to try and resolve these issues in residents best interests. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 6 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. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 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 the following standard(s): 2, 5. The home have not as yet been able to finalise the issues around the change from tenancies to licensees contracts and at present not all residents have written contracts. The managing organisations policy is to fully assess prior to admitting a new resident. EVIDENCE: There have been no new admissions since the last inspection. The managing organisation has a policy of not admitting new residents without a full assessment. At the last inspection there was a requirement that was originally set in 9/4/03 and extended to 1.6.05. This being that all residents have written contracts with terms and conditions. At present only one resident has this, stating the cost and that they occupy a single room. The most recently admitted resident did not have a contract on file The managing organisation are still trying to resolve issues around this with the Habinteg Housing Association. These issues date from before the home was registered and residents were being issued with tenancies and claiming housing benefit. They will now be issuing licences instead of tenancies. It has been agreed that one resident who has lived there a considerable time will retain his tenancy and remain able to claim housing benefit. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 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 the following standard(s): 6,7,9 Residents care plans give information about their needs and outline goals and changes. However, at times it was hard to find up to date information as the files are very full and out of date information is mixed in at times with the most recent information. Risk assessments are on file but are not all being reviewed and are at times difficult to see or find. Residents make choices and decisions about their lives and are well supported to do this by staff. EVIDENCE: Care plans contained information about residents individual needs and choices, these were comprehensive, but at times it was hard to identify what was the most up to date information about residents needs. Key workers hold regular meetings with residents every 6 weeks to 12 weeks. Goals are set at these meetings and they are further discussed at team meetings, six monthly meetings, as well as at annual reviews. Best Interest meeting are also held when required. Residents were supported to make choices about their day-to-day life. Two of the residents had no spoken language and communicate through looks, gestures and noises. Staff were familiar with how residents expressed their wishes in a non -verbal way and supported them in choices they were making Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 10 where possible. The staff work hard to try and involve residents in making choices, this is at times a challenging issues to work with, given the communication difficult some residents have. Risk assessments have been completed with all residents, some risk assessments were not being regularly reviewed and it was difficult to see some as there were several in one plastic holder on top of each other. Some had not being reviewed since 2003; one was around the issue of the resident and how he does not express pain. There was no indication on the care plan that this had changed or was no longer an issue but was not reviewed since 2003. This was the case with several risk assessments. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,15,16,17 Residents are supported to maintain links with family and access community facilities. They can access leisure activities, and staff response to non- verbal communications around choices and lifestyle. Specialist activities for two residents with complex needs and non-verbal communication have been difficult to identify, but staff are working hard to achieve this. Residents have access to a healthy diet. EVIDENCE: One resident has regular holidays with two carers accompanying him on these. An advocate supports the resident around making a choice about where this might be. Residents are supported to access various community facilities such as the theatre and the cinema, which they enjoy. The home has a car that enables them to support residents to go out in their wheelchairs and staff said that two of the residents enjoyed car rides a great deal. One resident would express his wish not to go out by dragging his feet if he did not want to go and staff would acknowledge that this was his main way of communicating his wish to remain at home on that occasion. One resident has made choices to spend a lot of Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 12 time in his room sitting on the floor. The staff have supported him to do this with bean bag seats and leaving things he likes to use e.g. percussion instruments on the floor within his reach, there were guidelines in the care plan around this choice. Two residents had used a hydrotherapy facility for some time and this had been something they had both enjoyed. This facility has now closed and staff have not identified a similar facility. One of these residents has also had to stop using a resource that he had attended for a long time due to funding issues, this coupled with the loss of the hydrotherapy has presented difficulties for staff in identifying suitable activities that these two resident could participate in. Other activities have been explored but will be activities that residents would be able to attend or watch, but not participate in due to the level of their disabilities, staff were aware of this, and are working with this, but identifying more suitable resources has been difficult. One resident is supported to spend time at home with his elderly mother every week and another resident whose father has died is being supported to try and establish contact with another family member. This is something that the home staff are pursuing gently with his family. Residents have access to a healthy diet; one resident is able to choose a menu for himself. The other residents likes and dislikes are known to staff. Fresh fruit is available. The resident spoken to said he enjoyed his food. There was a risk assessment around him not eating sweets at night. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, 21 Resident’s personal and healthcare needs are provided for and their physical needs met. The medication cupboards need to be kept locked at all time and staff need to be aware at all times in which cupboard emergency medication is kept. Residents needs and choices around issues of ageing and death are responded to. EVIDENCE: The staff member spoken to was familiar with residents personal support and their care plans. Staff were observed to be warm and caring in their response to residents and spoke with interest and sensitivity about the residents. Residents seemed relaxed and comfortable with staff. One resident spoken to said that he felt happy at the home Residents are supported to access health facilities they need, one resident is taken to hospital for dialysis three times a week and staff stay and support him whilst hospital staff complete the procedure. Some residents emotional needs may be complex and difficult to know and staff were aware of this. No residents are on self-medication programmes. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 14 The MAR charts and blister packs were looked at and all medication and signatures tallied. The medication given on a daily basis is kept in a locked cupboard in the kitchen. Other medication is kept in the cabinet in the staff room. The cabinet in the office was not locked when opened for inspection. The member of staff was surprised and was aware it should have been. Staff have received training in administering rectal diazepam, but were initially a little unsure which cupboard it was kept in. Staff need to be able to access this very quickly and should be always kept in one cupboard with nothing put on top of it that could prevent staff seeing it quickly. The home have put it in a bright green pack to aid with this. All residents have a funeral plan. Staff accompanied one resident to his father’s funeral when he died and staff worked to support him at this time. His key worker said that they were not sure if the resident understood what had happened but felt it was important he attended the funeral. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 A complaints procedure is in place but residents need support to use it. Staff are suitably trained with regard to protection from abuse. There remain issues around how best to support residents with regard to accessing and managing their finances. EVIDENCE: The complaints book was looked at. No complaints have been made since 21 November 2004. The organisation has a complaints procedure and an independent person investigates any complaint. Residents would need considerable support to complain and two would need family or an independent advocate to do this on their behalf. Two of the residents who have difficulties with communication are particularly vulnerable to abuse. The staff member spoken to has had training on protection of vulnerable adults and was aware that the residents at the home are particularity vulnerable due to communication difficulties. Staff have received training in adult protection. At the last inspection there remained issues around one residents bank account being frozen, which dated for the inspection in February 05. This situation has been partially revolved. A new bank account has been set up to enable to resident to access his welfare benefits. His savings are still in the frozen bank account and the bank will not release cash, but will issues cheques for large purchases. A best interests meeting is to be set up to look at what actions need to be taken to completely unfreeze the account and how best to support him in a more formal way in the future to access his money. The Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 16 funding authority social worker will be involved in this meeting and an advocacy invited. This issue remains not fully resolved. At present staff accompany this resident to the bank and support them to sign an X on the withdrawal form. They also accompany another resident and support him to mark an X. Neither resident may have the capacity to understand what they are signing. There is an arrangement in place that staff can only support the resident to withdraw a certain amount over that there must be two staff signature. All residents’ cash is kept in individual cash boxes and all money taken out and put in is signed for. Money is checked at staff handovers. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 24, 25,26, 30 The home is clean and comfortably furnished. Resident’s rooms are individually furnished and meet their needs and choices. Issues around padding in one residents room and the recommendation from the inspection of February 2005 remains unresolved due to funding issues at present, but it is hoped it will be resolved now in a fairly brief time scale. EVIDENCE: The home was on inspection homely and comfortable One resident has a ceiling track hoist and this was used the morning of the visit. The rooms has been pleasantly furnished. Staff have supported residents to have rooms that contain things that they like and have chosen themselves. One resident had on display various souvenirs he has brought back from holidays, and staff have put up pictures of his family and of himself. This resident has purchased a computer that he has in his room. This has been agreed by the funding authority, provided it was placed in his room. The resident is not able to operate it but his key worker will support him to watch the graphics in games, this he enjoys. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 18 At the last inspection it was recommended to resolve the issue around one resident who has padding gaffer taped to the wall and the wardrobe to prevent his from injuries. This had been looked at by occupational therapists and when they were unable to help referred to physiotherapist; they have assessed and given information on what could be used instead but will not agree funding for this. The home and social services had not initially agreed who would fund this The home have now obtained appropriate padded for this residents room and hope to install it soon. The garden fence is quite low and offers little privacy to residents and a higher one should be erected. The recommendation with regard to a sensory garden has not been acted on. The home was clean and hygienic. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 19 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33, 36 Staff have the skills needed to provide appropriate care for the residents of the home. However the registered provider needs to ensure that there are enough staff on duty to ensure that all residents needs can be met in line with their choices. Staff receive appropriate training and supervision. EVIDENCE: Staff were observed to respond with warmth and sensitivity to all the residents of the home and were familiar with their needs and means of communicating there wishes. The staff member interviewed was interested and showed commitment to supporting the residents to achieve their goals, increase their quality of life and independence. On arrival at the home at 9.40 a.m. there was one member of staff on duty, who was awaiting another member of staff to arrival, to then support a resident out of bed using the ceiling track hoist. The second worker arrived between 10 and 10.15am. There was for a period of time not enough staff on duty to enable the home to meet the residents wish to get out of bed if he had wished to exercise this choice. The home needs to ensure that enough staff are available to allow the residents to get out of bed and receive personal care earlier in the morning when they may wish this. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 20 At the last inspection there were 1.5 vacancies. There are still vacancies and staff reported that bank workers cover these. The member of staff on duty alone had not yet undertaken an NVQ. The staff member spoken to said that she had received regular training and the training records indicated that staff received training relevant to the work they do. All staff have NVQ qualifications except for one who will be starting their training this year. Staff receive regular supervisions. The staff member spoken to said that they found this helpful and supportive. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 21 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 Staff seek to involve other professionals in establishing how to fulfil resident’s wishes and choices. All risk assessments need to be equally visible and accessible. Health and safety issues are appropriately managed. EVIDENCE: Letters and information on care plans and files indicate that outside professionals have been involved in supporting residents and staff around complex and/ or specialist care issues The managing organisation has a policy to undertake monthly visits to the home by a manager from another home in the organisation. The home had a regular fire drill every Sunday and had a clearly display procedures to follow in the case of a fire. The fridge and freezer temperature were being monitored twice a day and signed. All hazardous substances were in a lockable cupboard. Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 22 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 Standard No Score 1 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 X X 3 X x 3 X Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 23 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 YA5 Regulation 5(b&c) Requirement The registered provider and manager must ensure that each resident is provided with a contract/statement of terms and conditions. Previous timescale of 01/06/05 remains unmet. The register provider must ensure the home is adequately staffed at all times to ensure residents choices around their personal care needs and the times that will receive this care. The registered provider and manager must ensure that the garden fence provides residents with a reasonable level of privacy The manager must ensure that all risk assessments are regularly reviewed, updated and signed by staff. The manager must ensure that case files are maintained in an orderly manner that ensures that current needs, goal and risk assessments are clearly visible Timescale for action 01/08/06 2 YA33 18(a)(c) (i) (ii) 01/04/06 3 YA24 23(2) e 01/05/06 4 YA9 13(4)b & C 15 (2)b 17 (3) 12/04/06 5 YA41 01/05/06 Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA26 YA24 YA23 Good Practice Recommendations The issues of the padding taped to one residents room to maintain his safely be resolved within the next few weeks as referred to in the fax of 17.2.2006 The issues of gaining funding for a sensory garden continue to be explored. The registered provider must clarify their arrangements with regard to how residents money is managed, hold a best interest meeting to make decisions about this and how to unfreeze the residents bank account Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Beatrice Road, 36 DS0000007107.V282709.R01.S.doc Version 5.1 Page 26 - 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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