Inspection on 06/06/05 for Bethune Court

This inspection was carried out on 6th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bethune Court 29/07/09

Bethune Court 23/08/06

Bethune Court 12/12/05

Bethune Court 07/01/05

Bethune Court 05/08/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Bethune Court 30 Boscobel Road St Leonards-on-Sea East Sussex TN38 0LX Lead Inspector Elizabeth Dudley Unannounced 6 June 2005 10:00 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bethune Court Address 30 Boscobel Road St Leonards-on-Sea East Sussex TN38 0LX 01424 719393 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) Anchor Trust Mrs Olga Blything Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (OP), 45 of places Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is forty-five (45). 2. Service users to be over sixty-five (65) years of age. Date of last inspection 7 January 2005 Brief Description of the Service: Bethune Court is a purpose built residential home on the outskirts of St Leonards on Sea in East Sussex. The home incorporates single flatlets for all residents which are furnished with resident own furniture, however furniture can be provided if required. There are several communal areas within the home, and a small well maintained garden, which is easily accessible to all residents of the home. Residents also run a small shop and library and hold meetings to decide what activities and outings they wish to take part in. The home holds many parties and photographs of these adorn the walls of the home. All residents can receive help with personal care, and local GPs and community nurses visit the home. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 6th June 2005 over a period of 6 hours, this forms part of the unannounced inspection programme for this home. Mrs Olga Blything, the home manager was present at the inspection and thanks are given to the manager, staff and residents for their co-operation, courtesy and hospitality during the day. During this visit to the home, 38 residents, five visitors, two community nurses and 10 members of staff were spoken with. What the service does well: The home provides a varied range of activities and these are decided by residents at their meetings. Photographs of the various events and outings adorn the walls of the home. The standard of catering is good and all meals are served in the dining room, the presentation of the tables and food is good. Separate dishes of vegetables are put on the tables in order that residents can serve themselves and the daily menu is displayed, but residents can eat their meals in their rooms if they so prefer. Menus are also discussed and decided at residents meetings. Staff attend a range of training and 55 of staff have gained their NVQ 2 in care. Community nurses that visit the home stated that they found the standard of care good. The manager has been in post since the home opened, 14 years ago, and her influence is apparent in the home. Many of the staff also have been at the home for this amount of time, ensuring the benefit of stability and good interaction between residents and staff. All residents spoken with stated that they were very happy within the home and one resident stated that ‘I couldn’t be in a better place, it is wonderful’. Likewise positive comments were made about the staff and manager, residents stating ‘ They are so kind’ and ‘ They are all wonderful’. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5, The home provides adequate information to enable prospective residents to make informed choices as to whether Bethune Court is the right choice of home to meet their needs. All residents are assessed by the manager prior to admission to determine whether the home can meet the physical and social needs of the resident. EVIDENCE: Information about the home is provided in the form of a statement of purpose and service users guide, of which all residents receive a copy. Some residents living in the home could not recall whether they have received a copy of this but the administrator stated that this is given on their admission to the home. A copy of the terms and conditions, which contains all the terms specified in this standard is also given to residents at the point of there admission to the home. Prior to admission all prospective residents are assessed by the manager who ensures that not only is the home suitable for the resident, but that the home can meet their care and social needs. Prospective residents are also invited to Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 9 the home to have lunch and meet other residents, their relatives are also welcome to visit and look around the home. Staff receive comprehensive training on meeting the needs of this people that are admitted within the home’s registration category. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Care plans show clarity in identifying the physical and social care needs of the resident , enabling staff to ensure that the care they are giving is meeting the assessed needs of the individual. Some risk assessments regarding self medication need reviewing in order to ensure the safety of the residents. EVIDENCE: A percentage of care plans were examined and found to include all information necessary to enable staff to carry out all personal care and include clear instructions on the moving and handling of each resident. They also include a pen picture of the resident giving a life history and their social interests. The majority of care plans showed that monthly reviews had been carried out and an in-depth six monthly review was undertaken. In most cases these had been signed by the member of staff carrying out the review and in the case of the six monthly reviews, by the resident. It was noted that in one care plan the review appeared to have been signed a month before it had been undertaken and the manager is clarifying this. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 11 All care plans contain risk assessments but in some cases, although reviewed monthly, no change had been made to the risk assessments since 2001. It is inevitable that some changes will have taken place since then and it is recommended that a complete review of risk assessments take place at least yearly. Community nurses were seen attending to residents and two spoken with stated that the care at Bethune Court was good, that instructions given by them were carried out fully. They also stated that in the case of those residents who had died at the home, the care that the nurses had identified as needing to be given, was always given correctly and that very ill people were treated with respect and dignity and were always kept comfortable. It was identified that staff are kind and helpful to relatives that were bereaved. Macmillan nurses have been involved within the home. One community nurse stated that she would be comfortable putting her relatives into this home should they need help. Medications were stored correctly and there was evidence of stock control. All controlled drugs were recorded and had double signatures and staff were aware of the importance of the strict recording of these drugs. Some staff have undertaken a medication course and these staff are responsible for giving out the medication, this was all signed for following administration. Two members of staff are involved in each medication round. Risk assessments for those residents who self medicate need to be reviewed at a minimum, monthly and should include the number of drugs left at the end of each month and an assessment of continuing capability of self administration and the residents appreciation of the importance of locking away their medication. The assessing member of staff should sign these. A requirement has been made around this issue. In one room a resident was seen to be keeping her medication on the bedside table and this should have been locked in the cupboard provided. Community nurses administer insulin. A nutrition profile has been undertaken on all residents and regular weighing of residents carried out if perceived as necessary. The community dietician was visiting one resident. Staff can accompany residents on hospital visits if relatives are unable to do so, and a dentist and physiotherapist can be accessed. A chiropodist visits the home, and all treatments by the nurses and the chiropodist are carried out in the privacy of the resident’s own room. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The home provides range of activities and entertainments whist maintaining resident choice as to whether they wish to join in with these. A good standard of catering with a varied menu chosen by residents is offered . The home allows residents to enjoy a good quality of life. EVIDENCE: Bethune Court offers a diverse range of activities and entertainment , these are decided by the residents at their meetings, which are held monthly. Evening entertainment is provided on occasions, and recently the home held a musical evening by outside entertainers ‘ Sounds about right’. The residents also compile their own newsletter, for which they write articles and poems. There are musical appreciation evenings, a library and a shop, run by the residents. Staff stated that resident’s lifestyle and choices around the activities of daily living are respected and that staff are aware of residents preferred times of getting up and going to bed. However one resident stated that the staff ‘come in and hurry you up a bit’, this view was not upheld by other residents and staff must ensure that residents do not feel they are made to rush. This was Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 13 not indicated during the visit, when there was an unhurried, relaxed atmosphere within the home. The home has an open visiting policy and maintains links with local churches. Meals are taken in a large dining room, and all tables were well presented with residents being able to help themselves to vegetables from serving dishes on the tables. The homes own surveys have identified that residents feel the serving and presentation of meals is good. A varied menu is offered which is also planned by residents at the meetings, the cook makes the majority of cakes and puddings offered and there is fresh fruit available at lunch and suppertime. Fresh vegetables are provided according to season. The daily menus are displayed in the dining room and choices are evident, with carers advising the residents the day before what meal is to be served and the choices available. Records are kept of the variety of meals served to residents daily. All residents stated that the food was’wonderful’, ‘beautifully cooked’ , and ‘nothing is too much trouble’, with one resident stating that ‘ its not bad cooking for an institution’. The kitchen was very clean and all catering staff are in possession of their food hygiene course, one member of staff is due to have his updated in the next month. All temperatures relating to food hygiene requirements are recorded an within the recommended parameters. The Environmental Health officer has recently visited the home and has made some requirements relating to new kitchen cupboards being provided, but otherwise the report was good. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Residents were confident that any concerns that they may have would be listened to and acted upon. Staff were aware of their responsibilities relating to the protection of residents within their care. EVIDENCE: A complaints policy is available to residents and visitors, this is in the service users guide and displayed on the notice board, the home also keeps a complaints log. The home receives very few complaints and the CSCI has not received any complaints about the home. Residents spoken with stated that if they had any concerns that they would go and see the manager and it would be sorted out. All staff have received training in the protection of the vulnerable adult and were aware of their responsibilities towards those in their care. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 Bethune Court provides a safe, clean, well maintained and pleasantly decorated home for residents. EVIDENCE: Bethune Court is a purpose built home on three floors, all floors are served by two shaft lifts and consists of 45 single rooms all with en-suite facilities. Communal accommodation comprises a dining room and small sitting areas plus large lounges on each floor, the dining room accesses a small well maintained garden. The home is well maintained and the previous requirement made to prevent the draught in the lounge from the patio doors has been met, however the maintenance person feels the problem may reoccur. The home is pleasantly decorated and have the carpets in the individual bedrooms are replaced when a resident leaves the home. Individual rooms Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 16 have lockable doors and a lockable cupboard. Most residents bring their furniture into the home with them, but the home can provide furniture if needed. The home has a few variable height beds which can be used if residents require these. Radiator covers and window restrictors are in place and water outlets are thermo-regulated, records are kept of the water temperatures and all were within recommended parameters. Communal bathrooms offering an assisted bathing facility are provided and these were clean, toiletries must be removed from these bathrooms after use to maintain resident safety. The home has been assessed by an occupational therapist and provides a range of aids to help independence as well as moving and handling equipment such as hoists. The home was very clean and staff were aware of basic infection control procedures. All laundry is done individually and red alginate bags are used for soiled linen. Recommendations that automatic sluicing facility is purchased have been made on several occasions, and the latest research on the spread of droplet infection should be taken into consideration by Anchor Trust. Residents and visitors commented on the cleanliness within the home and how it was free from any odours. The domestic staff are to be congratulated on their efforts in maintaining this pleasant environment. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staff turnover is low and staff receive induction training and ongoing training which ensures that residents have the benefit of being cared for by staff who are knowledgeable and with whom they are familiar. EVIDENCE: The home operates a key worker system with senior carers taking responsibility for determining the care needs of groups of residents. Staff spoken with stated that they felt that there were enough staff on every shift and that during times of staff absence, wherever possible staff were replaced by the homes own bank staff, or agency staff that were familiar with the home. They said that they do not often work ‘short staffed’ and did not feel overly rushed in their work. Residents also stated that there always seemed sufficient staff on duty to meet their needs and that their bells were answered promptly. Evening staff work until 10pm and then are replaced by two waking night staff. The home has 55 of staff who have attained NVQ2 and a further 7 staff working towards gaining this qualification. A further two members of staff have attained level 3 with 6 working towards this.This shows commitment by both the home and the staff, to ensure that the residents are receiving a good standard of care by knowledgeable staff. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 18 All staff receive an induction training which meets NTO guidelines, existing staff are also undertaking the TOPPS induction course. On the day of the visit, new member of domestic staff had commenced. She verified that she had commenced her induction that morning and was to receive moving and handling training in the next few days. Existing staff receive on-going training, some have received training in administering medication and the home is considering transferring this to an accredited course, the CSCI recommends that all care staff administering medication undertake an accredited course. All staff have a training profile, and documentation on their learning needs is available. There is a very low staff turnover, some staff having been at the home since it opened. Some personnel files for new staff were seen and it was evidenced that the home is now ensuring that all staff have work permits, POVA checks and CRB checks prior to commencing work. A requirement was made relating to this at the last inspection and this is now met. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37,38. EVIDENCE: Mrs Olga Blything has managed Bethune Court since it opened 14 ½ years ago. She is an RGN (level1), holds the Registered managers award and is on the Register of Accredited Social Workers. The ethos in the home is good. Residents made comments stating ‘I couldn’t wish to live in a better place’, ‘ staff treat us well’ and the staff ‘are angels’, ‘ everybody is so kind’, ‘ God put me in heaven before I died’. One gentleman stated ‘ Of course I like it here, I have to, got nowhere else to go so it’s a good job it’s so nice.’ All residents were full of praise for the way that the home is managed and staff stated that the manager was very approachable and listened if they had Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 20 problems or concerns. Visitors and community nurses made very positive comments about the home and the staff, and were full of praise for the care given to the residents. The home has a quality monitoring system in place and sends questionnaires to residents, visitors and health care professionals. It audits and acts upon these. All policies and procedures are reviewed regularly and staff evidenced that they were familiar with these. The home does not bank money for residents and does not act as appointee for residents. Money handed in for safe keeping is kept individually and records kept enabled a full audit trail of this money to be seen. All insurances were in place and accounts for Anchor trust have been seen in the past year. The manager takes part in the business planning and has control over how most of the budget is planned and spent. Formal supervision of staff takes place at approximately six times a year and records were seen of the planning of this as well as evidence that this is taking place. Registered provider visits take place monthly and reports are received by the CSCI. All care plans are kept in an office with a closed door and all other records are locked away All certificates relating to the servicing of utilities and equipment were seen to be in date. The IEE certificate was renewed two weeks ago and the home is waiting for this and the PAT testing is due in July 2005. Staff undertake mandatory training such as fire, moving and handling and first aid, and these has been attended by all staff. Records relating to staff attending and the dates due are kept. The manager states that magnetic closures are due to be put on all room doors in the near future. All liquids and toiletries must be removed from bathrooms for residents safety. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 4 3 3 3 4 4 3 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 4 3 3 3 3 3 3 Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 22 No 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. 2. 3. Standard 9 38 Regulation Reg 13(2) Reg 13(4) Requirement That self medication risk assessments are reviewed regularly. That all toiletries and liquids are removed from bathrooms following use for resident safety Timescale for action Immediate Immediate 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 38 7 26 Good Practice Recommendations That risk assessments undergo a complete review at regular intervals That staff do not sign review dates prior to them having taken place That an automatic sluice is purchased. Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 23 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Bethune Court H59-H10 S21051 Bethune Court V222753 060605 Stage 4a.doc Version 1.30 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!