Inspection on 20/09/07 for Blair House Nursing Home

This inspection was carried out on 20th September 2007.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blair House Nursing Home 05/04/06

Blair House Nursing Home 26/01/06

Blair House Nursing Home 17/10/05

Blair House Nursing Home 16/03/05

Blair House Nursing Home 17/06/04

Blair House Nursing Home 22/02/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Blair House Nursing Home Skirth Road Billinghay Lincs LN4 4AY Lead Inspector Roger Harrison Unannounced Inspection 20th September 2007 08:30 Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 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 Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 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. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blair House Nursing Home Address Skirth Road Billinghay Lincs LN4 4AY 01526 860432 F/P 01526 860432 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) www.craegmoor.co.uk Parkcare Homes Limited Mrs Glynis Branson Care Home 30 Category(ies) of Learning disability (29), Learning disability over registration, with number 65 years of age (1) of places Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition of Registration A Condition of Registration is that the maximum number of service users in each category is as follows:16 LD (Nursing) 13 LD (Personal Care) 1 LD(E) (Personal Care) Date of last inspection 5th April 2006 Brief Description of the Service: Blair House is part of the Craegmoor Group of homes. The home is located on the edge of the village of Billinghay. Blair House provides personal and nursing care for up to thirty (30) people with a learning disability from the age of eighteen years and above. The home consists of a two storey main house with ground level extensions that overlook either gardens or enclosed patio area. The home stands in its own grounds with gardens to front, rear, and car parking to the front and side of the building. Resident’s individual accommodation is provided in both single use and double occupancy bedrooms. Eleven of the bedrooms have en suite facilities. Blair House also provides day care for some permanent residents and offers two day-care places. The village itself offers a variety of amenities such as pub, shops and post office. The home provides transport to enable service users to participate in educational and recreational activities outside of the village. Fees at the home on 20/09/2007 currently range from: £407.00 £852.34 per week depending on the level of assessed care needs. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken by an inspector reviewing all the previous inspection records available, looking at information provided by the manager and residents about Blair House, and by undertaking a visit to the home, which took five hours to complete with the inspector using a method of inspection called “case tracking”. This method involved identifying individual residents who currently live at the home and tracking the experience of the care and support they have received during the time they have lived there. At the time of this inspection visit the registered manager was unavailable but the area manager and deputy manager were present throughout the actual visit. The inspection was also used to check that information provided about how care needs are currently being met matched the individual experiences of residents. This was achieved by talking to residents; the area manager and care staff whilst observing day-to-day care practice within the home. What the service does well: What has improved since the last inspection? What they could do better: The home environment is in need of overall refurbishment in order to provide residents with a safe, well maintained environment, which fully meets people’s needs. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 6 The manager should continue to monitor staffing levels to ensure that there are sufficient numbers of trained staff in place at all times to meet the needs of residents in a consistent way. 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. The summary of this inspection report can be made available in other formats on request. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 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 Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has a pre-admission assessment process in place, which is used to make sure that any new residents needs, wishes and aspirations are assessed. EVIDENCE: Information provided by the manager before the inspection visit showed that residents are provided with a service user guide which, has recently been improved so it is easier to read. It tells people about the home and what they should expect either before or when they move in. The manager also provided information to show that a statement of purpose is available for residents and visitors to look at which gives more details about the charges made for care and how the home provides support for those who live at Blair House. A copy of two new assessments were provided, which contained information that the manager had used to create a personal care plan. The area manager said that trial periods are used to check that any longer term needs can be met and that the assessment completed is used together with residents and their Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 9 family carers when reviewing the care provided. One resident told the inspector, “I made visits to the home, they met with me to talk about the things I like to have and do and my family helped me to choose, I like it here”. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are in place, which are reviewed to ensure changes in need and goals are acted upon to support residents to be as independent as possible. EVIDENCE: Before the inspection visit took place the manager provided written information to show that home owners have just started to introduce a new system for care plans, which is used to make sure residents are fully involved in creating their own plan. The area manager said that this system will be used for all new and existing residents and that the changes would help residents to take more control over decisions that are made about how their needs are met. The new care plans are easier to read and to understand and included risk assessments, which showed how residents are supported to take risks in a safe way either directly by the staff team or with support from other people like doctors, social workers and other health professionals. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 11 During the inspection visit a student was undertaking a placement at the home as part of her professional development. The student said, “It’s been a brilliant placement, I’m not just saying it. The staff really care, they know so much about the residents and this is shown in the way they use the care plans. The deputy manager is my mentor and she is good”. Daily records were available showing how residents are supported to do the things they had chosen to do. For example records stated that residents had support to dress and to eat and to get ready to go out to a range of activities that they had chosen to take part in. During the morning of the inspection visit a group of residents said they were looking forward to going out to different day centres, some residents were also being supported to attend appointments to see the doctor and one resident was supported to visit the dentist. Residents are provided with transport using the homes two mini buses. One of these buses has a tail-lift to enable people who need help to get in and out of the bus. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices about how they wish to live and the range of activities that they take part in, which ensures they have control over their lives. Residents are able to make choices in order to receive a varied, balanced diet. EVIDENCE: The area manager provided records to show that a number of residents attend day centres in the community and during the visit some other residents said they were going out to a coffee morning in the village. An activity organiser is employed at the home for five days a week to provide additional support for some residents during the day. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 13 Other support is provided using the key worker system in place at the home. For example; when people needed support to make decisions about whether to go on an outing or not. The care plans contain social histories and show how people like to be cared for. This information is used by key-workers to support residents with their decision making along with the use of the local advocacy service which supports support when needed for some residents who live at the home. Two residents said they attend church services and the activity organiser showed that she provides support with other activities such as arts and crafts, bowling, film shows and developing daily living skills like cookery. The cook plans menus every four weeks in advance and residents said they like the food that they have. The manager said that residents “Have your voice” meetings are used to help residents to talk about their meal choices and to discuss activities both inside and outside the home. A record of each meeting was provided showing how decisions were made about outings and other events, including holidays. Some residents need food to be prepared in a different way so that it is easier to eat. The cook keeps a list showing peoples needs, likes and dislikes which are taken from care plan information available and a comments book so that residents can say whether they like the food they eat. The area manager said that as a result of listening to residents and responding to one complaint made about the meals provided, the way food is purchased and menus are planned has been reviewed and improved recently and that the cook now purchases as much fresh food as possible. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents personal emotional and healthcare needs are met by the manager and care team in a way which encourages and supports residents to be as independent as possible. Records which show when residents need individual support with their medicine needs are used to ensure the right support is given to help people with their medicines. EVIDENCE: The manager said that she uses the assessments and care plan reviews completed individually and with family carers to encourage residents to be as independent as possible with support. The manager also provided information to show that support is provided for residents when taking medication where this is needed. During this inspection the deputy manager confirmed that all residents needed some level of additional support to manage and take medication. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 15 Medication is stored in a locked room within locked cabinets within the home and the manager confirmed that only nursing staff who have received training are allowed to support residents with medication. Care plans provided details about the medication needs of residents and during the visit one senior member of staff showed how residents are given the help they need to take their medication safely at the time prescribed. Records available were up to date showing what time support was given and by whom. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager takes complaints seriously and uses the complaints procedure in place to involve residents and carers in resolving issues as soon as they are evident. The Care team know how to act in order to protect residents from harm. EVIDENCE: Before the inspection visit took place the manager provided written information, which stated that concerns and complaints are dealt with as soon as they are raised. Company policies are used to help both staff and residents to understand how to raise concerns. The area manager confirmed that there has been one formal complaint made during since the last inspection about the food provided by the home. This complaint was responded to and the area manager took action to ensure a change in the way food is purchased was introduced immediately. Records were available to show the action taken. During the inspection visit details about how to raise concerns were on display in the service user guide. Residents said they knew how to raise concerns and that these were dealt with by the manager. Staff said that they were aware of the policy for raising concerns when they needed to as well and a procedure was on display in the home for staff to use. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 17 Staff records showed that training had been provided for staff to help them to know how to act in order to protect residents from harm. Residents said they felt safe and that the staff team were always available to talk to if they had any worries. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes environment is aged and worn and is in need of refurbishment as this affects the quality of life for residents. EVIDENCE: Before making this inspection visit the area manager provided some written information to confirm that an environmental audit had been completed so that plans could be drawn up showing areas of the home environment, which needed to improve. This audit has been submitted to the home-owners for approval during the last year and has been returned to the manager for more information. This has delayed any agreement to commence the work needed and the homes structure has deteriorated. An agreement has been reached for some work to commence to improve the kitchen area. This work will be starting on 8th October 2007, and will include Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 19 the fitting of new kitchen equipment to replace the current equipment in place because it is in poor condition. During a tour of the building the environment was observed to be generally in a poor state of repair throughout and refurbishment is needed in order to maintain the quality of care being provided by the staff team and to provide a suitable living environment for those who live at Blair House. The area manager said that she recognised that many areas of the home are in need of refurbishment, ongoing decoration and maintenance. For example, parts of the communal areas of the home, in particular the bathrooms, carpets and furniture in the main lounge are in need of refurbishment and replacement and parts of the outside of the building, including the garden areas are in need of appropriate maintenance. Three residents showed the Inspector their rooms during the visit. Some rooms had been decorated and residents had helped choose the colours but other rooms were in need of new carpets, furniture and being redecorated. Some beds were damaged with torn mattresses and some wardrobes and cupboards had handles missing, which made them difficult to open. One resident said, “I would like my room to be decorated but don’t know when it will be”. Other communal areas were viewed and the majority of areas seen were clean, with hygiene practice followed by the care team to minimise risks to residents. However, the overall environment had deteriorated due to lack of maintenance. During the inspection visit the inspector made contact with the home-owners operations director who confirmed that the environmental audit report is going to be considered very soon and that a decision to begin the work to improve the overall environment will soon be made. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,33, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are currently sufficient numbers of safely recruited care staff available at the home with appropriate training and skills to meet the needs of residents. EVIDENCE: Before carrying out this inspection visit the manager provided information, which included staff rotas, which showed that staffing levels are balanced using a shift system. This includes a night care team for the home. Members of the care team said that there had been some difficulties covering rotas due to absences and that when this occurred it had been difficult for them but that they felt they currently had enough staff available to meet the needs of residents safely. One staff member said, “We work well as a team and make sure we get the rotas covered. It has been hard but we ensure residents are well looked after”. The rota for the shift covered showed that there were staff in sufficient numbers to meet residents needs. During the inspection visit some residents said they were not able to go to a coffee morning in the village because the activity organiser had to cover Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 21 another staff members work. The area manager said that she some absences have had to be covered using time that would otherwise be spent supporting residents with activities in the home in order to make sure residents physical and other social needs could be met but that this had been kept to a minimum. During the inspection visit staff files were provided, which showed that references and checks are completed to make sure recruitment is carried out safely. The deputy manager also provided a detailed training plan with training records on individual files to show that staff members are supported to undertake a range of training courses to help them to provide care for residents as highlighted in their care plans, this includes nationally recognised qualifications. The training plan showed that training has been provided in abuse awareness, moving and handling, fire safety, care planning and risk assessments since the last inspection. Residents were observed being supported in a sensitive and caring way by team members and said they trusted the staff team and one resident said, “I know my key worker helps me and I can talk to her”. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a competent Registered Manager in post who understands the needs of each individual resident. Resident’s benefit from the support given to staff by the manager in maintaining residents physical, emotional and social needs at the centre of the care giving process. EVIDENCE: The Manager was registered with the commission to undertake the role of Registered Manager since November 2005. During this inspection visit the registered manager was not available but the deputy manager and area manager demonstrated a “hands on approach” which residents responded to positively. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 23 Members of staff said that the manager is always when needed to support them in their duties and that while is not available there are management arrangements in place to make sure staff are supported to provide care in a safe way. One resident said he enjoyed spending time in the manager’s office and said, “I like being here, they look after me and the manager and staff are my friends”. Residents said that the manager listens to them if they want to discuss any issue and residents said that the “Your Voice” meetings had been held every month since March this year and that they had helped them to be involved in decisions which affect them. Records were available to show that the meetings had taken place and showed who had attended. The area manager said that one resident had chosen to attend a national “Your voice” group meeting to represent the views of the residents at Blair House and that the resident would be attending future national meetings which have been organised by the home-owners. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 24 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 1 25 2 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X 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 X 3 X 3 X X 3 X Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 25 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. Standard YA24 Regulation Requirement Timescale for action 20/11/07 23(1)(a)(2)(b)(2)(0) The home is in need of major refurbishment in order to ensure that the needs of all residents can be met. 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 YA33 Good Practice Recommendations It is strongly recommended that the manager continues to monitor staffing levels, and take action when needed to ensure that there are sufficient numbers of trained staff in place at all times to meet the needs of residents consistently. Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Blair House Nursing Home DS0000002532.V341756.R01.S.doc Version 5.2 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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