Inspection on 05/07/07 for Bourne Bridge House

This inspection was carried out on 5th July 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 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

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Bourne Bridge House Meshaw South Molton Devon EX36 4NL Lead Inspector Jo Walsh Key Unannounced Inspection 5th July 2007 09:00 Bourne Bridge House DS0000068932.V339429.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 Bourne Bridge House DS0000068932.V339429.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. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bourne Bridge House Address Meshaw South Molton Devon EX36 4NL 01884 860909 01884 860909 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) Meadowbank Care Limited Miss Michelle Elizabeth Edwards Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users are not to be admitted to Beech Cottage and Bramble Cottage until a further site visit has taken place and the Commission has agreed that these two cottages meet the National Minimum Standards. The number of service users admitted shall not exceed four until a further site visit has taken place and the Commission has agreed that Beech Cottage and Bramble Cottage meet the National Minimum Standards. N/A 2. Date of last inspection Brief Description of the Service: Bourne Bridge House is a registered care home for adults with a learning disability and complex needs. The service offers accommodation in four self contained houses that surround a square of attractive gardens. Currently only two of the houses are operational. All bedrooms are en suite and each house has a kitchen, dinning and lounge area. All areas are decorated and furnished nicely and people who live at Bourne Bridge House are encouraged to personalise their own rooms. The site is in a rural part of north Devon, the nearest local facilities are approximately four miles away, where there is a shop, post office and pub. Transport and seven days day care is included as part of the residential package, in order to facilitate access into the local community, college and amenities. The current range of fee are from £2400 to £2424. Fees are based on assessment of need and include high staffing ratios. The fees do not include personal toiletries. The manager has stated that copies of this inspection report will be available throughout the home for people to read. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As this service currently only has two people living there, short notice was given to the home to ensure that the inspection took place at a time that people who live there would be available. During this inspection both new people who have recently moved to Bourne Bridge House were spoken to about what it was like living there and how they were settling in. Time was also spent talking to staff on duty. Three care staff were spoken to as well as the administrator and handy man/gardener. Surveys were not used on this occasion, but two relatives were contacted by phone to get their views about how well the home was running and their comments are included. Two professionals who had placed individuals at the home were also asked for their views. During the inspection, the registered provider was available for some of the time and the registered manager was available throughout the day. Some time was spent touring the building including two of the houses that are now almost completed. Key documents were looked at and discussed with the registered manager and staff. These included individual care plans, records of medications administered, behaviour management plans and records relating to incidents of behaviour that challenges. Staff records in relation to recruitment and training were also seen. Records in relation to ensuring the environment is kept safe were also looked at, these included fire log book, temperature checks on hot water outlets, and thermometer checks on the fridge and freezer. The inspector would like to thank the people who live at Bourne Bridge House, the staff and management for their time and helpfulness throughout the inspection. What the service does well: Bourne Bridge House provides a very homely and peaceful environment in a cluster of small homes that have been renovated and furnished to a high standard. The registered provider has developed a detailed process of assessment prior to individuals moving in. This ensures that the staff understand and can plan Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 6 for people with complex needs and behaviours that sometimes challenge. The assessment process was commended by two care managers and a parent who said that ‘’ the assessment and transition process was excellent, it gave my relative time to get to know staff before moving in and gave me an opportunity to feel confident that staff could manage the care and support needed.’’ Each person who lives at Bourne Bridge House has a clear, concise care plan that enables staff to provides care and support in a consistent way and in a way that the individual prefers. This ensures that all personal, health care and social needs are identified and goals put in place to maximise independence within a risk management framework. The staff team have a variety of experience and are currently undergoing training to ensure they can meet the needs of the people who live at Bourne Bridge House. Staff spoken to said they had a five day training course on personal intervention prior to any people moving into the home. They are also doing training to ensure they can do their job safely and competently. Courses undertaken or scheduled to take place shortly include moving and handling, first aid, fire safety awareness, first aid and basic food hygiene. All staff spoken to said they were impressed by the level of commitment from management to ensure that there training needs was being met. One staff member said they had worked in previous homes and had not had anywhere near the quality of training they have had since starting with this home. People who live at Bourne Bridge House are protected by robust recruitment processes, staff having a good understanding of abuse and by detailed records for recording when methods of restraint are used. What has improved since the last inspection? What they could do better: Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 7 The home are aware of the need to ensure that all electrical equipment brought into the home is safe, and have completed visual checks, and are looking into who could do more detailed testing. Once people are more established in their new home, the registered manager intends to use surveys to ensure that individuals are given a say about reviewing the quality of care and support provided. This will help to further develop their quality assurance programme. 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. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 8 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 Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 9 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): 1,2,4,5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. All prospective new people have their individual aspirations and needs fully assessed prior to moving in to ensure that this is the right service for them. EVIDENCE: Bourne Bridge House has clear information for any prospective new people to enable them to understand what the service offers and to help them and their carers and funding authorities decide if this is the right placement for them. This information includes a service users guide and statement of purpose, which explains what will be offered and what their rights are. The assessment processes were looked at and discussed with the registered manager. She explained that they try to tailor the assessment and introduction to the service to suit the individual. One person had visits to their home by staff over a period of months and then they prepared a book with photos to help the individual understand the change in moving from their family home to Bourne Bridge House. Another person was assessed over a shorter period of time spending time with them in their previous placement before moving to this house. One care manager commended the service for the way in which they completed a through assessment process stating that they sent staff to the persons current placement to work along side staff who knew the person. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 10 The assessments contained detailed information to help staff understand what the individual needed to feel safe and secure in their new home. The information also had clear details about their medical needs, social history, details of what they enjoyed doing and who was important to them. This information helped staff to them plan their transition and care into their new home. The level of detail was impressive and the registered manager had clearly planned for each new admission in a way that met the individual needs. Care staff spoken showed a good level of understanding of the needs of individuals to date. The home had also got assessments and reports from previous placements and carers to further develop their knowledge of the individual. One person who lives at Bourne Bridge House said that they had come to see the house before moving in. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 11 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): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal goals and needs are reflected in individuals’ plans of care, this helps to ensure that people are supported to make decisions and develop their independence. EVIDENCE: Plans of care for the two people who live at Bourne Bridge House were looked at and discussed with the registered manager and the staff team. The plans are clearly written and give staff good information about what the individual can do for themselves, what they need support in and what they are working towards in terms of personal goals. One person had only been at the home for a few days and was settling in so had not been involved in the development of their plan as yet. The other person had been assisted to understand their care plan by the use of photos, about what activities they do, and this seemed to be working well. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 12 Staff spoken to said they had good information available in care plans and this helped them to better understand their needs and what strategies worked in calming difficult and challenging behaviours. Each plan had a detailed risk assessment that looked at the aim and goal of an activity, what risks were identified and what strategies should be used to minimise risks. These were very clearly written and provided good information about how risks had been assessed. One person living at Bourne Bridge House showed me some of the photos of activities they had done so far and said they had liked doing some things ‘’I love Calvert Trust, I won the race’’ Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 13 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): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Bourne Bridge House are able to take part in activities that suit their needs and wishes and are supported to access the local community and maintain family and friends contacts. EVIDENCE: The registered manager explained that care packages are set up to include staff support to facilitate visiting family and friends. She gave the example of one person being assisted to visit their family with staff staying at a local travel lodge and staff support being available as needed. One person, who lives at the home, has been placed there from outside of the Devon area and their care manager said that as part of the care plan package it has been agreed that staff will facilitate a visit to their hometown once a month. This will enable them to see family and meet any cultural needs. One person who lives at the home said that their parent had been to stay with them and that they really enjoyed this. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 14 Each individual is offered a range of activities that suits their needs and wishes. This is in the early stages so staff are still trying out various options, such as college courses, horse riding, trips out to places of local interest. As the two people who currently live at Bourne Bridge House are new to the service, staff are still working with them to establish routines that suit their needs. Any restrictions on individuals such as access into the kitchen area unsupervised is clearly documented with a risk assessment and states clearly the reasons why and how further independence will be worked towards. People who live at Bourne Bridge House are supported to make choices about what they would like to eat and it is hoped that they will get involved in menu planning, shopping and helping to prepare meals. Menu plans seen show a good variety and choice is offered. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 15 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): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Bourne Bridge House are supported in their personal and health care needs in a way that suits them. They are protected by the home’s policies and procedures for dealing with medications. EVIDENCE: Care plans give clear and concise details about individuals needs in terms of their personal and health care needs. This means staff are able to provide care in a consistent way. One care manager commented that behavioural issues have ‘’greatly reduced due to the consistent approach of the staff.’’ High staffing ratios allow for a flexible daily routine to be in place for each person who lives at Bourne Bridge House. Health care needs are clearly identified within the care plans of individuals. Where specific conditions or health needs have been identified, addition Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 16 information about the health issue has been included. This helps staff to better understand the needs of the people they support. The service has a contract with a consultant psychiatrist who will provide advice and support as needed. People are registered with the local general practitioners for their general health care needs. Each house has a secure place to store medications. None of the current people who live at Bourne Bridge House have been assessed as being able to manage their own medications. Staff administer medications and record using MARS charts. The records appeared accurate and well maintained. Staff have had some training in the safe handling and administering of medications and this is backed by the homes policy, which is covered during the induction process. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 17 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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Bourne Bridge House can be confident their views and concerns will be listened to and acted upon EVIDENCE: The home have a stated complaints procedure that is included in the initial information they people receive about the service. The registered manager explained that they would ensure that people understand the process for making their concerns known to staff in a way that they understand. To date there has been no complaints made to the service or the Commission. The registered manager said that once people have settled in they will plan to have regular meetings and that where needed independent advocates will be used. The registered provider completes an unannounced visit once a month and speaks to people who live at the home and to staff about ant concerns or suggestions they have to improve the service. Staff are due to complete training in the protection of vulnerable adults, which will help them to identify any potential abuse issues. Staff are only employed once they have completed relevant checks to ensure that they are suitable to work with vulnerable people. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 18 The home has a good system in place for documenting individuals’ monies and this is checked daily by staff and monthly by the registered provider. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 19 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): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Bourne Bridge House have a very comfortable and safe environment. EVIDENCE: Only two of the four houses are completed to date. They have been renovated and furnished to a high standard. All bedrooms have en suite facilities and each house has a kitchen area, lounge and dinning areas. The houses are situated around a garden area that is attractive and level for easy access. One of the people who live there uses a wheel chair and needs specialist equipment to enable staff to provide support safely. Tracking hoist equipment has been installed as well as a walk in shower/wet room that enables staff to provide personal support in a well-designed space safely. A tour of all houses was completed and the two currently in use were clean and very homely. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 20 Laundry facilities are sited away form the kitchen and dinning areas and are accessible to people who live there. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 21 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): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at Bourne Bridge House are supported by a staff team that are well trained, competent and supported to do their job effectively. EVIDENCE: Information provided by the registered manager states that 50 of staff have or are working towards a nationally recognised training programme in care (NVQ2 or above). All staff is currently undergoing induction training that meets nationally recognised standards and covers all key areas to ensure staff are able to do their job safely and competently. Three staff files were seen during this inspection and they all contained details to show that checks had been completed to ensure that they were appropriate to work with vulnerable adults (CRB and POVA First checks), before they commenced employment. Two references for each staff were also on the files. This shows that the home have a robust recruitment process that helps protect the people who live there. Training in key areas such as personal intervention, fire safety, medication training has all been completed before people moved into the service. There is Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 22 an ongoing programme of training for staff and two spoken to said the level of commitment to training was really good. All staff including the administrator and handy man are completing the programme of training. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 23 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): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Bourne Bridge House benefit from a service that is well run. EVIDENCE: Michelle Edwards the registered manager has just completed her nurse training in learning disabilities and is now doing her registered managers award. She has had previous experience of working and managing services for people who have learning disabilities and complex and challenging behaviours. Staff spoken to said that they felt supported and believed their views were listened to by the registered manager. One said ‘’ she makes herself available, and if we have had a difficult shift we have a debrief session which means we are not having to take our concerns home with us.’’ Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 24 As the service has only recently taken on two people, it is too early to assess their methods of ensuring the views of people are listened to in reviewing the quality of care provided. Surveys have been devised but not yet used and individuals are only just settling into the service. The registered provider ensures he visits the service on a regular basis and once a month produces a report on who he has spoken to what issues or concerns have been raised. Staff had have had or planned to have training in key areas such as moving and handling, fire safety, first aid, food hygiene and infection control. This ensures they are able to do their job safely and competently. Systems are in place to ensure the health and safety of both the people who live at the home and the staff. These include regular checks on water temperatures and regular servicing of all equipment. Good risk assessments are in place for all safe-working practices and these will be reviewed on a regular basis. All staff are in the process of completing a comprehensive induction programme. One staff member said they had not previously worked in the care setting before and had found the induction process invaluable in being able to fully understand the role and responsibilities of supporting people with complex needs. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 25 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 3 2 4 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 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 Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 26 N/A 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. Standard Regulation Requirement Timescale for action 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 YA42 Good Practice Recommendations The home should ensure that all electrical equipment is tested to ensure is safe and well maintained. Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Bourne Bridge House DS0000068932.V339429.R01.S.doc Version 5.2 Page 28 - 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. 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