Inspection on 09/05/06 for Birdhurst Gardens

This inspection was carried out on 9th May 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 no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Birdhurst Gardens 22/05/07

Birdhurst Gardens 21/11/05

Birdhurst Gardens 31/05/05

Birdhurst Gardens 26/07/04

Birdhurst Gardens 26/04/04

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 Birdhurst Gardens 15 Birdhurst Gardens South Croydon Surrey CR2 7DT Lead Inspector James O`Hara Unannounced Inspection 9th May 2006 07:50 Birdhurst Gardens DS0000025755.V291118.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 Birdhurst Gardens DS0000025755.V291118.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. Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Birdhurst Gardens Address 15 Birdhurst Gardens South Croydon Surrey CR2 7DT 020 8680 6876 020 8681 1649 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) Surrey Oaklands NHS Trust Mrs Ruwami Trabelsi Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2005 Brief Description of the Service: Birdhurst Gardens is registered to provide care for up to nine adults with learning disabilities. There are currently seven service users living at the home. The home also provides respite care to four service users. Birdhurst Gardens is situated in a quite residential street of similar properties in south Croydon. The home is a large detached property built over three floors. Each of the service users has a single bedroom; there is also a communal lounge/dining room as well as, bathrooms, an office and kitchen. To the rear of the premises is a pleasant garden, which is well used in the summer months. The home has an outside laundry facility and parking to the front. Birdhurst Gardens DS0000025755.V291118.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. Methods of inspection included a tour of the premises, discussion with some of the service users and discussion with members of staff on shift. The home manager, Mrs. Sowambur was not available on the day of the inspection. Records examined included the service users care plans, person centred plans, menus, risk assessments, health care correspondence, staff training records, fire records, service user activity plans, and the homes visitors book. The ten requirements and two recommendations from the last inspection were discussed with Mrs Hermina Austin a member of staff who supported the majority of the inspection process. Mrs Austin provided evidence were she could to meet the requirements. What the service does well: What has improved since the last inspection? During the last inspection it was recorded that staff had difficulty in arranging transport to take the service users to the day service. There were three drivers employed at the home but none of them were working that morning. The situation has improved in that staffing rosters are completed ensuring that there is a driver on each shift. A number of requirements set at the last inspection have been met. New dining room chairs have been purchased for the service users and the bath panel on the ground floor bath has been replaced. All staff has attended training on epilepsy. The new home manager has applied to the Commission For Social Care Inspection to become the registered manager for the home. Birdhurst Gardens DS0000025755.V291118.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. Birdhurst Gardens DS0000025755.V291118.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 Birdhurst Gardens DS0000025755.V291118.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. Information available to prospective service users is good. No new service user has moved to the home since the last inspection however all the procedures are in place should they be needed. EVIDENCE: It was evidenced at a previous inspection that the homes Statement of Purpose contains all of the details as stated in Schedule 1 of the National Minimum Standards. A senior member of staff on shift stated that no new service users have moved into the home however one service user who has used the homes respite service is currently undergoing assessment to see if he can be suitably placed at the home on a long term basis. In general the Surrey and Borders NHS Trust ensures that new service users know about what the home offers and appropriate assessments are carried out. Birdhurst Gardens DS0000025755.V291118.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 and 9. Service users plans are generally good and are reviewed on a regular six monthly basis however the Person Centred Plans do not include the level of personal care a service user needs and the service users preferred routines. EVIDENCE: Two service users files were examined. Both service users files included a completed health action plan (not dated). Activity plans for the day service at Geoffrey Harris House and the home. Both service users had a My Plan (Person Centred Plan) that includes a communication profile, my relationship circle, what matters to me and support me with my health and keep me safe. Sections under the headings My Dreams and Things that are not working in my life had not been completed in one of the service users My Plans. The service users plans had been reviewed on a regular six monthly basis. It was noted at the last inspection the level of personal care support a service user needs and the service users preferred routines was recorded in the My Plan but not in the Life Plan. It was stated by the previous registered manager that this should become clearer when the home completes service users Person Centred Plans. Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 10 However this information was not included in the two Person Centred Plans examined. This requirement will be examined at the next inspection. It was noted that one of the service users Person Centred Plan was completed in the first person i.e. I have a yearly health check making sure I am fit and well. The other service users Person Centred Plan was written about them. It is recommended that the home move towards the Person Centred Plan approach were ownership of the plan is given to the individual service user and the service users thoughts and opinions are recorded in the first person. One service users file included evidence that he had had his needs assessed by a care manager however the other service user had no record of having had her needs assessed. The home manager must contact all of the service users care managers and make arrangements for the service users assessed needs to be kept under review. Evidence of reviews must be available in the home for inspection. Both service users have had individual risk assessments and risk management strategies carried out thus enabling them to participate in activities in the home and in the community with appropriate support. Birdhurst Gardens DS0000025755.V291118.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 and 17. Provision is made so that all service users attend appropriate social activities, day centres and become part of the local community. Dietary needs are well catered for and well-balanced, nutritional meals, based on personal preferences are being prepared and eaten by the service users. EVIDENCE: During the last inspection it was recorded that staff tried to arrange transport to take the service users to the day service. There were three drivers employed at the home but none of them were working that morning. A requirement was set that the home manager must ensure that at all times appropriate plans and arrangements are in place so that service users can attend their planned daytime activities. The senior member of staff on shift during this inspection stated that the situation has improved in that staffing rosters are completed with an emphasis on ensuring that there is a driver on each shift. Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 12 The service users have a varied programme of social activities with an emphasis on using community facilities. They attend day services at Geoffrey Harris House four days per week from Monday to Thursday. Each Friday the home organises a community activity such as bowling, swimming or a trip to the cinema. A record of all the service users activities is kept on their files. They also use the local pub and go into nearby Croydon to restaurants and cafes. Members of staff on shift stated that one service user has regular visits from his family. Other service users keep in contact with relatives and friends by letters or telephone. Recently the new home manager invited service users relatives to the home to introduce her self to them and there are plans to hold barbeques and invite service users friends and relatives. Food menus are based on a four-week rota and are based on the likes and dislikes of the service users and are then checked by the trusts dietician for nutritional balance. The home has made a pictorial menu for the service users. Menus seem varied and also included some ethnic option meals. Service users are offered an alternative to the main meal on offer. Service users weekly activity records indicate that service users are supported to prepare and cook meals for themselves and others in the home. Birdhurst Gardens DS0000025755.V291118.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 and 20. Suitable arrangements are in place to ensure that service users physical and emotional health care needs are identified and met. The homes policies and procedures for handling medicines in the home ensure the service users are so far as reasonably practicable protected from harm and/or abuse. EVIDENCE: Two service users files were examined. It was noted that both service users were very well supported with their health care needs. Both service users files included a completed health action plan. Both service users had the support of a General Practitioner, Optician, Dentist and Psychologists. One service user suffers from epilepsy was under the ongoing review and monitoring of a Neurologist. He also has the support of a Speech and Language therapist. As required at the last inspection all members of staff has had training on epilepsy. One service user is diabetic and a Diabetic Specialist Nurse has trained a number of staff on the administration of insulin. Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 14 Birdhurst Gardens DS0000025755.V291118.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 and 23. The home has an appropriate complaints procedure in place. The home has suitable vulnerable adult protection and abuse prevention measures in place to ensure the service users are so far as reasonable practicable protected from abuse, neglect and/or harm. EVIDENCE: The homes complaints procedure is completed in text and picture (Widget) for the benefit of some of the service users. Most of the staff team attended training on adult protection on the 15th November 2005 a number of staff had attended adult protection in 2004. A member of staff on shift demonstrated that she was aware of the homes complaints and adult protection procedures. Birdhurst Gardens DS0000025755.V291118.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, 27, 28 and 30. The home is suitable to the needs of the service users and is in good decorative order throughout. The overall impression when visiting this home is that it is homely, comfortable clean and hygienic. EVIDENCE: In general the home is in good decorative order. New dining room chairs have been purchased for the service users and the bath panel on the ground floor bath has been replaced as required at the last inspection. It was noted during the inspection that the bath on the ground floor was blocked. It is recommended that the home manager contact the works department to unblock the bath. Weekly activity records indicate that service users are supported in the kitchen to prepare and cook meals. It was noted that some of the cupboard doors had water damage and in particular a drawer had sharp broken edges that could potentially scratch or cut service users or staff using the kitchen. The home manager must ensure that the kitchen drawer with sharp broken edges should be repaired or replaced. Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 17 Most of the service users have large spacious comfortable bedrooms decorated to their own personal preferences. It was noted that the carpet in one of the bedrooms smelled. The member of staff on shift stated that the service user had been sick and the carpet was due to be cleaned. It is recommended that the home manager contact the works department and arrange for the carpet in the service users bedroom is cleaned. Birdhurst Gardens DS0000025755.V291118.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): 32, 34, 35 and 36. Staff at the home appears to be well trained and supervised. The home has a committed and well-established staff team that have worked together for a number of years, there has been very little staff turnover and this has been of great benefit for the service users, providing stability and consistency. Staffing records such as Criminal Records Bureau Checks and staffing information still require inspection. EVIDENCE: The home manager was not present on the day of the inspection so confidential staff information was not accessible to for inspection. The senior member of staff on shift was advised to contact the home service manager to inform them that an inspection was in progress. Requirements that the home manager contact the Commission when she obtains information as required in Regulation 19 (1) b and Schedule 2 National Minimum Standards (This requirement is unmet from inspection 31st May 2005.) and that the home manager contact the Commission when she receives the Criminal Records Bureau Checks for two members of staff and arrange a date for these to be inspected could not be assessed. (This requirement is unmet from inspection 31st May 2005.). Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 19 One member of staff on shift stated that she and another member of staff had recently received their Criminal Records Bureau Checks. The home manager must pay particular attention to these particular outstanding requirements. As required at the inspection on the 31st May 2005 that the manager ensure that all staff has an annual appraisal. One member of staff on shift stated that she had had an appraisal and that she is supervised on a regular monthly basis. This requirement will be reviewed at the next inspection. The member of staff on shift stated that one new member of staff had started working at the home since the last inspection. This member of staff had been redeployed from another Surrey and Borders NHS Trust care home. The member of staff on shift stated that she is completing an NVQ level 2 in Care. Staff training records indicates that all staff attend regular training on epilepsy, medication, health and safety, moving and handling, first aid, food hygiene, adult protection and fire safety. Birdhurst Gardens DS0000025755.V291118.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, 39, 40 and 42. The new home manager is supported by an experianced deputy manager and a well-established staff team. The overall impression when visiting the home is that it is well organised. EVIDENCE: The home manager was not available on the day of the inspection. She is a first level registered nurse. She had worked at the Gables another Surrey and Borders NHS Trust care home since 1993 and had been the home manager since August 2000. It was reported at the last inspection that the home manager and another home manager from another Surrey and Borders home had swapped homes. As required at the last inspection the home manager has applied to the Commission For Social Care Inspection to become the registered manager for the home. She was completing the Registered Managers Award and NVQ level 4 in Care. The home manager must send a copy of her NVQ level 4 certificate to the Commission. Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 21 Three members of staff spoke positively about the new home manager’s approach to the managing the home and felt that she has continued to keep services provided at the home at a good standard. A recommendation was set at the last inspection that staff read, sign and date as evidence that they have read and understood all the homes new policies and procedures. The member of staff on shift showed evidence that some staff had signed new policy and procedures but not staff had done so. The homes fire records were examined. The home has a fire risk assessment in place and a full fire evacuation was carried out on the 6th April 2006. The weekly fire alarm checks record indicated that it had been tested on the 16th April 2006 no other entries were made. The member of staff on shift stated that checks were carried out weekly but was not sure where the record was kept. The home manager must ensure that weekly fire alarm checks are carried out and that all staff is aware of the location of the weekly record. Service users files contained completed questionnaires, staff had supported service users to fill these in and information gained will be used with the relative’s feedback to improve services at the home. Birdhurst Gardens DS0000025755.V291118.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 X 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 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 X 2 X 3 3 X 2 X Birdhurst Gardens DS0000025755.V291118.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 YA6 Regulation 14(2) Requirement The registered manager must contact all of the service users care managers and make arrangements for the service users assessed needs to be kept under review. Evidence of reviews must be available in the home for inspection. The home manager must ensure that the level of personal care support a service user needs and the service users preferred routines are recorded in the Person Centred Plans. This requirement is unmet from previous inspection 31st May 2005 and 21st November 2005. The home manager must ensure that the kitchen drawer with sharp broken edges should be repaired or replaced. The new home manager must contact the Commission when she obtains staff the information as required in Regulation 19 (1) b and Schedule 2 National Minimum Standards and arrange a date for these to be inspected. This requirement is unmet DS0000025755.V291118.R01.S.doc Timescale for action 31/08/06 2. YA6 15(1). 14/06/06 3. YA24 23 (2) b 31/08/06 4. YA34 19(1) b 14/06/06 Birdhurst Gardens Version 5.1 Page 24 5. YA34 19(1) b. 6. YA35 18(1) c. 7. 8. YA37 YA42 9 (1) b 23 (4) c from previous inspection 31st May 2005 and 21st November 2005. The new home manager must contact the Commission when she receives the Criminal Records Bureau Checks for two members of staffs and arrange a date for these to be inspected. This requirement is unmet from previous inspection 31st May 2005 and 21st November 2005. The new home manager must ensure that all staff has an annual appraisal. This requirement from inspection 31st May 2005 could not be fully inspected. The home manager must send a copy of her NVQ level 4 certificate to the Commission. The home manager must ensure that weekly fire alarm checks are carried out and that all staff are aware of the location of the weekly record. 14/06/06 14/06/06 31/08/06 31/08/06 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. Refer to Standard YA6 Good Practice Recommendations It is recommended that the home move towards the Person Centred Plan approach were ownership of the plan is given to the individual service user and the service users thoughts and opinions are recorded in the first person. It is recommended that the home manager contact the works department to unblock the bath. It is recommended that the home manager contact the works department and arrange for the carpet in the service users bedroom is cleaned. The inspector recommends that staff have to sign and date DS0000025755.V291118.R01.S.doc Version 5.1 Page 25 2 3 4 YA27 YA24 YA40 Birdhurst Gardens as evidence that they have read and understood all the homes new policies and procedures. Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Birdhurst Gardens DS0000025755.V291118.R01.S.doc Version 5.1 Page 27 - 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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