Inspection on 22/08/07 for Brant Howe

This inspection was carried out on 22nd August 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

Brant Howe 15/02/06

Brant Howe 21/09/05

Brant Howe 15/09/05

Brant Howe 06/12/04

Brant Howe 17/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Brant Howe Fairbank Kirkby Lonsdale Carnforth Lancashire LA6 2DU Lead Inspector Ray Mowat Unannounced Inspection 22nd August 2007 09:00 X10015.doc Version 1.40 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 Brant Howe DS0000022581.V344220.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brant Howe Address Fairbank Kirkby Lonsdale Carnforth Lancashire LA6 2DU 015242 71832 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) Paul@branthowe.co.uk Mr Paul Martin Jackson Mrs Emma Louise Jackson Mr Paul Martin Jackson Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 25 service users to include: up to 25 service users in the category of OP (Old age, not falling within any other category) The home should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 15th February 2006 Date of last inspection Brief Description of the Service: Brant Howe is registered to provide personal care and support for up to 25 elderly people. The home is situated in a residential area in Kirkby Lonsdale with easy access to shops and transport. The home has four floors with the ground and first floor only being used to accommodate service users. The top floor is used for staff accommodation and the laundry is sited in the basement. On the ground floor there are two lounges and a conservatory and two dining areas. There are 11 single bedrooms and 4 double rooms although not all of these are used to accommodate 2 people. There is a modern extension that provides bedrooms and communal living space for an additional six residents and has been built in a style that complements the existing building. There is also a new single storey building in the grounds to provide an office for the manager and staff accommodation. Information is supplied to residents and prospective residents in the form of a brochure, which is kept under review. The fees for the home range from £363 to £490. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to this inspection visit I received an annual questionnaire about the running of the home and the quality of the service provided. It is also a selfassessment against the National Minimum Standards (NMS), which provides detailed information. During the visit I spoke to many of the people living in the home, the care staff on duty and friends and families who were visiting the home. I also spoke to visiting professionals and spent time with the manager. Questionnaires were also sent to the same groups of people as part of the inspection. I looked at information in personal files, which provide staff with information about how people like to be cared for and what is important to them in their lives. I also looked at information relating to the running of the home and maintaining the safety and welfare of staff and the people living there. What the service does well: People are given sufficient information, to enable them to make an informed choice about moving into the home and their rights once they move in. People’s needs are assessed and they are able to visit the home to make sure it is suitable for them. Personal and healthcare needs are monitored and appropriate referrals made to other agencies to make sure people get the support and adaptations they need to promote a healthy and independent lifestyle. On the whole staff get good training including training in specialist areas such as end of life care. People are able to exercise choice and control over their lives and enjoy a variety of social activities. There is a high level of satisfaction with the meals provided with menus based on feedback from people living in the home. There is a stable staff team who provide a consistent, reliable and good quality of care. Feedback from relatives confirmed this with comments such as “the staff are kind and caring” and “the staff are wonderful nothing is too much trouble”. The home is well managed and is run in the best interests of the people living there. It is comfortable, safe and well maintained with good systems in place to ensure people are safeguarded. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedures make sure peoples needs are assessed and they make an informed choice about moving into the home and get appropriate support through the process. EVIDENCE: People living in the home and people visiting the home with a view to moving there, are all issued with an informative service user guide and brochure. They are also supplied with the Statement of Purpose, which includes valuable information about the running of the home including the previous CSCI inspection report. This process ensures people and their representatives are given suitable information to make an informed choice about moving into the home. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 9 All the people living in the home are issued with a contract (for self funding people) or a terms and conditions of residence for people funded by Adult Social Care services. This includes information about the fees payable and what care and services they include, any additional services that may be charged and people’s rights and obligations. Thorough assessments are completed either by a Social Worker or for selffunding people by one of the management team prior to the person moving in. This may be carried out in the person’s own home, the hospital or at Brant Howe during a visit. The assessment is in line with the requirements of the NMS and provides suitable information for the home to develop an informative care plan, which is agreed with the person or their representative. Through the monthly review of the care plan the needs of the person are assessed and monitored and any changes in need responded to. The admission procedure encourages people to visit the home prior to making a decision about moving in, this gives people the opportunity to see if they like it and can raise any queries or concerns they may have. Once they decide to move in a four week probationary period is agreed so that both parties can ensure the move is right before making a firm commitment. The home works closely with other agencies to make sure people get the support they require at what can be a difficult time. Wherever possible emergency admissions are avoided but if they occur the admission procedures are completed within five working days. Brant Howe does not provide intermediate care. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good knowledge of individuals and ensure their personal and healthcare needs are responded to appropriately. Information recorded by staff makes sure people receive a consistent service. EVIDENCE: Based on the detailed assessments that are completed on admission to the home, senior staff compile individual care plans, which are agreed and signed by the person or their representative. They contain information to guide staff in supporting people with their personal and healthcare needs and include individual risk assessments ensuring people are safeguarded. The care plan is reviewed with people on a monthly basis and any changes are recorded, signed and dated. An informative social history has been developed that gathers Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 11 personal information that is important to the individual and ensures staff are aware of significant events and relationships in their lives. This gives staff a greater understanding of the person and their needs. Specialist advice and support are sought from other professionals regarding key areas such as pressure care, nutrition and continence ensuring people receive appropriate support, aids and adaptations to maintain and promote their independence. A range of risk assessments are completed including key areas such as manual handling, falls risk assessment and pressure care assessment. When risks are noted action to be taken to reduce or remove the risk are recorded. People said they can make “everyday choices in their lives” and get “support and encouragement to be independent”. I also met several visitors to the home who confirmed that people are “well looked after and want for nothing”. Staff encourage people to maintain their abilities with exercise being an important area where staff promote independence. This could be walking in the home environment, joining in an exercise class, which are always popular, or walking in the grounds or around the local community. All staff that are responsible for administering medication have completed NHS approved training with their practice monitored through formal supervision. Since the last visit medication storage and procedures have been reviewed and improvements made to ensure people’s safety at all times. I checked the contents of the monitored dosage system and other medication held against the records. These were clearly named and labelled with photographs used for easy identification. The medical records examined were up to date and accurate. Controlled drugs were securely stored with suitable records maintained to manage their administration. The manager has introduced a monthly audit to monitor all aspects of the storage, stock control and administration, which is good practice. Staff record people’s wishes upon illness or death including their religious and cultural beliefs or personal preferences. The home has a clear policy relating to ‘care of the dying’ and will make arrangements for families to stay with people in the last part of life if they so wish. Staff have recently received training on supporting people in “end of life care”. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On the whole people are leading a fulfilling lifestyle and are supported and encouraged to exercise choice and control in all aspects of their lives. EVIDENCE: It was evident from my discussions with the majority of people that they exercise choice and control in many aspects of their lives. As one person said to me “we can do what we want when we want to do it”. Organised social activities are planned by staff based on people’s preferences. These can be one to one activities or group activities. They also include sedentary and non-sedentary activities ranging from board games and tabletop activities to the more energetic things such as chair exercises or going out for walks. Special occasions and significant festivals are celebrated dependent on people’s cultural and religious beliefs. Services of different denominations are held in the home and some people are supported to attend the local church by staff. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 13 I met with several visitors throughout the day who all confirmed that they are “made welcome” in the home. There are no restrictions on visiting times other than those made by personal choice. As part of the initial assessment people are asked about their personal routines and what is important to them in their daily life. This includes things such as what time to get up, preferred drinks, preference for a newspaper etc. which all help to ensure people can live their preferred lifestyle. People are asked about their food preferences on a regular basis and menus are altered accordingly. I joined a group of people for lunch in the main dining room who were very complimentary about the food in the home. They said “its always fresh and home cooked” and “the food is marvellous if anything we get too much”. People are given choices about what they want and when and where they eat it. As a result of recent consultation the menus are now going to be changed more frequently. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People feel safe and well cared for with their concerns responded to. Policies and procedures ensure people are protected at all times. EVIDENCE: The home has a suitable complaints policy and procedure that is displayed in the home in addition to being issued to people in the literature that is given to all new and prospective residents. A copy is also included in the visitor’s book ensuring family, friends and representatives have easy access to it. All complaints are recorded in a complaints log and investigated in line with the procedure. No formal complaints have been recorded since the last inspection visit. People are encouraged to vote at both local and general elections. Assistance is given to get people to a polling station or they are assisted to register for a postal vote. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 15 Based on discussions with staff and the manager there is a good awareness among the staff about what constitutes abuse and the relevant reporting procedures. The induction programme includes abuse awareness with staff being familiarised with relevant policies and procedures including reporting procedures, whistle blowing, financial procedures and dealing with violence and aggression. Staff awareness is also checked out at formal supervision sessions. Staff spend time with people on a regular basis to discuss what they call “cares and concerns”, which gives people an opportunity to raise any issues they wish. A record of these are maintained and any action taken in response. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Brant Howe provides a safe and well-maintained living environment. There is sufficient equipment and facilities to promote independence and ensure people are comfortable. EVIDENCE: Brant Howe prides itself on the quality of the environment and has a programme of repairs and renewals, which ensures all areas are safe and well maintained. Planned maintenance has been identified with clear timescales, in addition when rooms become vacant they are redecorated. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 17 The grounds and gardens are kept safe and well maintained with the home having their own gardener. There is wheelchair access from the conservatory with a paved area for people to sit and socialise. The home has met all the requirements of both fire and environmental inspections. The home has adequate communal space providing people with a good choice of places to relax or socialise. There are two dining areas where people can enjoy meals in relaxed and comfortable surroundings, alternatively meals can be eaten in the privacy of their own rooms. The bathroom and toilet facilities are suitable to meet the needs of the people living in the home. Two bathrooms have been recently enlarged to accommodate people who use a wheelchair. There are also assisted baths and manual handling aids and adaptations that ensure personal care needs can be met appropriately and people’s privacy and dignity is maintained. Separate sluices are also in place. Appropriate referrals are made to other professionals, including the Occupational Therapist, to ensure specialist needs are acknowledged and suitable aids and adaptations are in place to support and promote independence. These include raised toilet seats, commodes, manual handling hoist, grab handles and rails. Rooms are personalised with people bringing in their own furniture and belongings if they wish, which gives them an individual and homely feel. All rooms have a lockable facility for people to keep personal valuables. All areas of the home are clean and hygienic with many of the people I spoke to commenting on its cleanliness and the fact there are no malodours. One person described the home as “providing a warm friendly atmosphere, in a clean safe environment”, another said, “it couldn’t be better, it’s so clean and comfortable”. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team are experienced and well trained and ensure people receive a consistent and reliable service that meets people’s individual needs and preferences. EVIDENCE: The home prides itself in maintaining a stable staff team who are committed to providing a consistent and reliable service. Residents described the staff as “wonderful” and “marvellous” another person said “nothing is too much trouble they do anything for you”. Staff are well supported with the manager or senior staff providing formal supervision on a regular basis. A record of this is maintained which both parties sign with actions being agreed. Personal development and training needs are discussed with any training shortfalls identified and recorded. Staff I met said they “get regular training” and “good support and supervision, we can raise any issues”. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 19 The home has developed a ‘skills for care’ induction procedure for all new appointments. Over 50 of staff has completed their NVQ qualifications with the home giving successful candidates a financial reward. There are sound procedures in place to make sure all necessary checks are completed on new staff. This includes obtaining two references, POVA and CRB checks. Staff are issued with a contract of employment and a code of conduct including relevant policies and procedures. Staff spoken to had a good understanding of their role and the needs of the people they care for. I met several visitors during my visit including visiting professionals, family and friends or relatives. They all commented consistently about the “how nice the home is” and “how caring the staff are”. A survey I received described the staff with the following comments “staff are warm, caring and kind and offer a service as close to a ‘home’ as is possible”. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a well run home where they feel safe and well cared for. Good systems are in place to ensure the home is run in their best interests and their independence is promoted. EVIDENCE: Mr Paul Jackson is an experienced and well-qualified manager who ensures the home is running efficiently and effectively and in the best interests of the people living there. There are sound systems in place to make sure people’s views are heard and incorporated into the development plan for the home. These include an annual quality questionnaire, house meetings, staff meetings Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 21 as well as one to one consultation with both people living in the home and staff. There was evidence issues raised by people had been discussed at a ‘residents’ meeting and actions agreed with them. Based on my own observations and discussions there is a positive atmosphere in the home, with the staff “working well as a team” and enjoying good relationships with the people they care for. As mentioned previously the home produces an Annual Development Plan based on feedback from consultation with people using the service, their friends or relatives, staff and other professionals. Individual feedback or aspirations are recorded in care plans, which are agreed and signed by people or their representative. Internal audits and evaluation takes place on a regular basis to monitor the home’s compliance with relevant legislation and ensure all aspects of the service are safe and in line with good practice guidelines. The home does not handle any personal finances on behalf of people if required they have a family member or independent adviser to support them. All the records examined were up to date and accurately maintained. They are securely stored in line with Data protection guidelines, however remain accessible to people as and when required. Records relating to Health and Safety and other legislative requirements were examined and found on the whole to be in order, however when manual handling needs are identified a more detailed strategy should be developed to guide staff and ensure a consistent approach that maintains the safety of staff and the person being moved. The manager has introduced a new monitoring system through an internal audit, to ensure records are accurate and up to date, which is good practice. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 x 3 3 3 3 Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP38 Good Practice Recommendations When manual handling needs are identified a more detailed strategy should be developed to guide staff and ensure a consistent approach that maintains the safety of staff and the person being moved. Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Brant Howe DS0000022581.V344220.R01.S.doc Version 5.2 Page 25 - 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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