Inspection on 10/04/06 for Beech Trees

This inspection was carried out on 10th April 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beech Trees 03/10/05

Beech Trees 23/05/05

Beech Trees 21/10/04

Beech Trees 23/06/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Beech Trees 1A Kirby Road Horsell Village Woking Surrey GU21 4RJ Lead Inspector Pauline Long Unannounced Inspection 10th April 2006 08:00 Beech Trees DS0000055261.V288762.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 Beech Trees DS0000055261.V288762.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. Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beech Trees Address 1A Kirby Road Horsell Village Woking Surrey GU21 4RJ 01483 276195 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) scilla.roe@brookhurstcare.co.uk Brookhurst Care Limited Pamela Anne Callanan Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the adults accommodated, one (1) may also fall within the category PD (physical disability). 3rd October 2005 Date of last inspection Brief Description of the Service: Beech Trees is situated in a quiet residential area of Horsell Village, a short distance by car from Woking town centre. Beech Trees is a tastefully converted older style property, which is a home for young adults with a learning disability. The home is also registered for one young adult with an associated physical disability. The accommodation consists of six individual en suite bedrooms, five of these being on the first floor and one on the ground floor. There is no lift access to the first floor. Communal areas consist of a dining room, sitting room and easily accessible kitchen and laundry room. Both the dining room and sitting room have French doors leading to a medium sized secure back garden. The home has a small area for parking at the front, but parking is available on the road outside. Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit as part of the key inspection in the CSCI year April 2006- March 2007 and was unannounced. The inspection was carried out by one inspector and lasted for six and a half hours. The service had a homely lively and welcoming atmosphere. On the day three of the six residents were at the home. The remaining three residents were spending time at their parents homes. Discussions were had with the residents, manager and care staff who were on duty. Documents inspected, included residents files and care plans, staff records, and policies and procedures. A full tour of the premises took place. On the day feedback from the residents was limited in view of their communication difficulties. CSCI would like to thank the residents and staff for their hospitality and cooperation during the inspection. The Home’s website address is: www.brookhurstcare.co.uk. What the service does well: What has improved since the last inspection? The majority of the requirements made at the last inspection were met. The environment in the communal rooms has improved, for example new pictures, curtains, candles and storage chests are in place. Some of the resident’s bedrooms and the communal hall stairs and landing have been re painted. A new fridge/freezer and tumble dryer have been purchased. New specialist equipment has been purchased for an individual. Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 6 Three new members of staff have been recruited. Policies and procedures in respect of residents monies have been reviewed an updated. 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. Beech Trees DS0000055261.V288762.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 Beech Trees DS0000055261.V288762.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): 2,3,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure a full needs assessment takes place before any new admission. Each resident has an individual signed contract. EVIDENCE: There have been no new admissions to the home since the last inspection. Those resident in the home have had a comprehensive assessment of needs, to include all aspects of daily living. Discussions with the manager and senior carer demonstrated that the manager and care staff would be fully aware of residents care needs. The homes contract/ terms and conditions were easy to read and understand. It was positive to note that the manager and staff had supported some of the residents to sign their contracts. Beech Trees DS0000055261.V288762.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs and choices were well documented and the staff had a good understanding of them. Residents are encouraged to participate in all aspects of life in the home. EVIDENCE: Two of the residents care plans were sampled and these contained a comprehensive needs assessment. Care plans included all aspects of personal support and changing health and social care needs. During the inspection staff were observed discussing the days activities with the residents, choices were given in respect of the days outing and where to go for lunch. Residents are encouraged to take responsible risks and are supported by staff in this respect. Risk assessments were well documented and there was evidence that they were regularly reviewed and updated as the need arose. The home has developed a service user questionnaire, which has been developed in both pictorial and written format. Enabling those residents with Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 10 communication difficulties to be involved in giving feedback. It was positive to note that they were actively seeking the views of the residents in respect of all aspects of life in the home. The inspector sampled one of the returned questionnaires and found the feedback to be positive. The manager and care staff indicated, that the residents are encouraged to carry out some of the domestic tasks around the home for example: cleaning their bedrooms, preparing their meals and helping with the shopping. Beech Trees DS0000055261.V288762.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): 12,13,15,16 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager and staff enable the residents to maintain fulfilling lifestyles in and outside the home, and promotes contact with family, friends and the local community. EVIDENCE: This is a very lively home, with lots of activity and noise. A TV in the lounge was on and one of the residents was happily singing alone to one of the tunes. The residents at Beech Trees are not in paid employment, however some of them do attend the local college and various day services. Whilst the staff at the home support them to these various activities, the residents are enabled to have a degree of independence, and the opportunity to meet with other day service users. There were no college activities on the day as the inspection was carried out during the Easter break. However the residents were preparing to go out for the morning to the local ten pin bowling club. The manager stated that she was in the process of arranging further activities for the Easter break. Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 12 The routines in the home were determined only by the timings of the planned activities. Two of the residents were up and ready for the day, one was enjoying a leisurely bath. Two of the residents were asked if the inspector could view their bedrooms, and the residents were happy for this to happen. One of the residents was happily watching the television the other was looking at a catalogue and invited the inspector to have a look as well. The home is committed to ensuring that the residents maintain their relationships with their family and friends. Three of the residents had spent the weekends with their families. The inspector did not observe a meal times activity in the home, however the care staff stated that, the all of the residents were able to choose their meals from pictorial and written menus. A daily record is kept in respect of food eaten by the residents. Special diets would be arranged for residents with specific dietary needs. Beech Trees DS0000055261.V288762.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and staff have a good understanding of the residents support needs and health needs, which were well met. This was evident from the positive interactions and relationships observed. EVIDENCE: The care plans sampled, included guidelines on any support each resident required with personal and health care. Physical and emotional needs of the residents were also detailed in the care plans and daily records, which included visits to the doctor, dietician, dentist and reviews of care. There were records with regard to the activities and care being given. Each resident is issued with a personal journal which would be taken with them when they go to spend time with their families. The manager stated that this document would be used as another form of communication, which would enable families to record any significant events. The home has a clear medication system in place. None of the residents in home administers their own medication. All of the medication record sheets were checked, and were found to be properly completed. There were up to date photographs of the residents on each of the sheets. To date the home has not had a pharmacy audit in respect of their medication procedures. This was Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 14 discussed with the manager, who stated that she would speak with the pharmacy which supply the homes medication. A recommendation has been made in respect of medication. Please refer to pages 24 and 25 of this report. Beech Trees DS0000055261.V288762.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory policies and procedures in place for dealing with concerns, complaints and the protection of the residents. EVIDENCE: CSCI has not received any complaints since the last inspection. The homes complaints/ compliments book was sampled, and there was evidence to indicate that 10 complaints had been made since the last inspection. These complaints had been dealt with according to the homes complaints procedure and had been satisfactorily resolved. The complaints policy requires updating as it does not reflect the current management arrangements in the home. There has been one adult protection referral since the last inspection. Meetings have been held in respect of this referral and have been satisfactorily resolved. Various scenarios in respect of abusive situations were discussed with the senior carer on duty, it was positive to note that she had a good understanding of the homes policies and procedures around the protection of adults from abuse. Three new members of staff have been recruited since the last inspection, two of them have undergone training in the protection of vulnerable adults. The manager stated that she would ensure the third member of staff would be booked on the next available course. Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is satisfactory. EVIDENCE: A full tour of the home took place. The furniture, fittings and decoration reflected that of any busy family home. The manager has recently supported some of the residents to choose new colour choices and to redecorate their bedrooms. New specialist bedroom furniture has recently been purchased in respect of a residents individual needs. Respect for residents privacy has a high priority at this home, each resident has a key to their own bedroom and they are encouraged to use them. One resident happily demonstrated that his bedroom door was locked and that he held the key. The communal areas of the home have recently been painted providing brighter and cleaner accommodation. New curtains, storage boxes, candles and paintings have been provided in the sitting room, providing a more homely appearance. The loose covers on the sofas are faded and soiled in some areas and will require attention / replacement in the near future. The hallway has also been re-decorated to a satisfactory standard. The carpets in the communal areas are a cream colour and subsequently soil easily. The Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 17 manager stated that they are regularly cleaned. The home may have to consider alternative flooring. New domestic equipment has been bought for the home for example: a new fridge freezer and a tumble dryer. Whilst overall the kitchen was clean and well maintained , there are areas which require attention. The floor area at the base of the kitchen units was soiled and will require cleaning. The floor area around the dishwasher has been damaged by water, causing the flooring to lift and to be potentially a trip hazard. The manager stated that it had been recently repaired, however it requires further attention. Requirements were made in these areas. Please refer to pages 24 and 25 of this report. Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 18 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): 33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home employs an efficient well supervised staff team in adequate numbers, who provide a good quality of care to the residents. However on the day some of the records required were not on file therefore did not reflect thorough recruitment and selection practice. EVIDENCE: On the morning of inspection staffing levels were adequate for dependency levels of the residents, and consisted of a manager, one senior care assistant and two care assistants. There are no domestic or kitchen staff employed at the home, the cooking and cleaning is part of every one’s day-to-day work. Discussions were had with one member of staff, who had worked at the home since it opened. She had a clear understanding of homes policies and procedures and there was clarity and awareness in the different staff roles and responsibilities within the home. Three new staff have been recruited since the last inspection and their personnel files were sampled. On the whole all of the required paper work was in place, however the files require attention in respect of ease of use. They were somewhat cumbersome, and as a result the manager was unable to Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 19 verify that all of the required checks had been carried out in respect of Criminal Records Bureaux (CRB) checks. This was somewhat disappointing. The home has a training and development programme in place. There was evidence to demonstrate that the following training courses had been booked for the first half of the year: LADF, First Aid, Health & Safety and Manual Handling and Vulnerable Adult Protection. There is a formal one to one staff supervision programme in the home. It was positive to note that all of the staff had received individual supervision from either the manager or deputy. A requirement has been made in respect of recruitment records. Please refer to pages 24 and 25 of this report. Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 20 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): 37,38,39,40,41,42,43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from the ethos and management approach of the home. Their views are listened to and acted upon. Policies and Procedures were in place to safeguard service users and the standard of record keeping was satisfactory. Health and safety checks are routinely carried out at the home. EVIDENCE: The manager has been in post since October 2005. On the day she demonstrated an open and inclusive approach and management style. From observation of her interactions with the residents and staff it was clear that there was an atmosphere of openness, understanding and respect. There are comprehensive policies and procedures in the home. Residents and staff can access them when they wish. Following a referral under the local authority Adult Protection Procedures the homes financial policies and procedures have been reviewed and updated to ensure safe accounting. Resident’s monies and records were sampled and were found to be in good Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 21 order. It was therefore disappointing to note a discrepancy in the petty cash accounts. The home holds resident’s meetings in which the care staff support the residents to express their views. It was positive to note that a service user survey had been developed and distributed to residents and families. Action plans were in place in response to comments received. Discussions were had with the manager around the benefits of seeking the views of other health and social care professionals and other stakeholders. Throughout this inspection the home records were accessed. The recordkeeping was of a satisfactory standard. As discussed earlier in this report, the personnel files require attention to ensure that paperwork is not misplaced. Residents and staff records are stored appropriately, securely and confidentially. Health and safety checks are routinely carried out and records kept. Records evidenced that water temperatures, fire drills and fire bells were regularly checked. Kitchen records in respect of fridge, freezer and food temperatures were on the whole well maintained. A requirement and a recommendation have been made in these areas. Please refer to pages 24 and 25 of this report. Beech Trees DS0000055261.V288762.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 3 4 X 5 3 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 2 25 3 26 2 27 3 28 X 29 2 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 3 3 3 3 2 3 X Beech Trees DS0000055261.V288762.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 YA24 Regulation 23(20(d) Requirement The registered person(s) must ensure that the home has a planned and documented maintenance and renewal programme for the fabric and decoration of the home. Previous timescale of 03/01/06 not met The registered person(s) must ensure that the sealant around the baths and showers is replaced as necessary. Previous timescale of 03/11/05 not met The registered person(s) must ensure that a wheelchair ramp is fitted outside one of the garden doors to enable access from the house to the garden. Previous timescale of 10/12/05 not met. The registered person(s) must ensure that the homes complaints procedure is reviewed and updated to reflect the current management arrangements. The registered person(s) must ensure that prescription creams are stored appropriately in a DS0000055261.V288762.R01.S.doc Timescale for action 10/05/06 2 YA24 23(2)(d) 10/05/06 3 YA24 23(2)(n) 10/05/06 4 YA22 22 17/04/06 5 YA18 12(4)(a) 13(1)(2) 10/06/06 Beech Trees Version 5.1 Page 24 resident’s bedroom. 6 YA34 19(10) 17(3)(b) The registered person(s) must ensure that all staff employed have the relevant checks and that these are recorded in staff files. The registered person(s) must ensure that the all areas of the home are kept clean and in good condition, attention must be paid to floor area in the kitchen. The registered person(s) must ensure that procedures in respect of the homes petty cash transactions are adhered to. 17/04/06 7 YA24 23(b)(c ) 10/05/06 8 YA43 13(6) 25(3)(a) 11/04/06 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 Refer to Standard YA42 YA41 Good Practice Recommendations The registered person(s) should review the appropriateness of providing tablets of soap in the communal bathroom and toilets. The registered persons should review the present systems for maintaining staff records. The present system is somewhat cumbersome and has the potential for documents to be misplaced. The registered person(s) should review/ renew the loose covers on the sitting room furniture. The registered person(s) should consider their local pharmacy undertaking an audit of the homes medication systems. 3 4 YA24 YA20 Beech Trees DS0000055261.V288762.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Beech Trees DS0000055261.V288762.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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