Inspection on 16/11/06 for Briarfields

This inspection was carried out on 16th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Briarfields 06/12/05

Briarfields 14/07/05

Briarfields 06/12/04

Briarfields 08/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Briarfields Raby Crescent Belle Vue Shrewsbury Shropshire SY3 7JN Lead Inspector Pat Scott Key Unannounced Inspection 16th November 2006 10:00 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 Briarfields DS0000020663.V296996.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. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Briarfields Address Raby Crescent Belle Vue Shrewsbury Shropshire SY3 7JN 01743 353374 01743 232943 briarfields@coucareshrop.demon.co.uk www.coveragecareservices.co.uk Coverage Care Services Ltd 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) Carole Jane Williams Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: Briarfields is registered with the Commission for Social Care Inspection to provide a residential care service to 40 older people. The home is situated in Belle Vue close to Shrewsbury town centre. It is a well established home set in its own grounds. Briarfields is one of a number of care homes run by the ‘Coverage Care’ organisation. The registered manager Ms Carol Williams manages the home on a day-to-day basis. Briarfields offers single room accommodation for 38 service users and one shared room. The home has been designed to provide sitting, recreational and dining space in 4 separate areas. The garden is well maintained and accessible providing a safe attractive area for residents to use. A separate day centre is also on site. Coverage Care Services Ltd make their services known to prospective service users in: The Statement of Purpose, Company Brochure and web site which also contain their contact e mail address. The inspection report is mentioned in the statement of purpose and summarised in the service user guide. It is also on display in all homes’ entrance halls with a note stating the document can be made available to copy and take away. Coverage Care Services rates are reviewed annually on 1st April each year and service users are notified one month in advance. The only additional charges to service users are for toiletries, hairdressing, newspapers and escorting to hospital for routine appointments. This is clearly laid out in the terms and conditions. Fees for Briarfields as of 1st April 2006 are: £372-£394. All service users pay monthly by standing order or by cheque usually on the 15th of the month. This is two weeks in advance and two weeks in arrears. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: management, quality audits, home visit information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? The end of life care initiative has been trialled in the home. The manager and staff have improved performance in this area and have been successful in providing skilled, quality care during what can be a distressing time for service users and their family. Past medication errors have been addressed and procedures made more safe. The information provided to staff on specific training topics has improved. When training is attended it is cascaded down to all levels of staff. Research by Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 6 the manager identifies areas of care that can be improved upon to meet national practice and guidance e.g. infection control. 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. Briarfields DS0000020663.V296996.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 Briarfields DS0000020663.V296996.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Key standards 1.2.3.4. The homes statement of purpose and service user guide provides service users and prospective users with details of the services the home provides, enabling an informed decision about admission to the home. Assessment of need is conducted in a respectful and plain speaking way so that service users understand their needs will be met during their stay. EVIDENCE: Prospective service users are given the opportunity to spend time in the home. An individual member of staff is allocated to give them information and help them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 9 The staff team are qualified and experienced to work with the needs of the service users. Documentation and training profiles seen show that specialist areas of work have been explored and that staff have access to detailed guidance and training materials. An information pack is in service users’ bedrooms. The home provides a statement of purpose (SOP) that clearly sets out the objectives and philosophy of the service supported by a service user guide that summarises the SOP and provides good clear information about the home. The guide is precise in what the prospective service user can expect and gives a good detailed account of the quality of the accommodation, qualifications and experience of staff, how to make a complaint, recent CSCI inspection findings and contains comments and experiences of service users living at the home. All residents are given a copy of the guide. Each service user is provided with a statement of terms and conditions prior to moving to the home. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the service user. This is clear, jargon free, easy to understand and gives the service user a very clear understanding of what they can expect. Terms and conditions are reviewed yearly. Assessments were seen to have been conducted prior to a service user entering the home. The home are then able to confirm that they can meet the needs of the individual through the service they deliver as detailed in the statement of purpose. For people whom are self funding and without a care management assessment the assessment is always undertaken by a skilled and experienced member of staff. Care plans reviewed confirmed that the assessment is conducted professionally and sensitively and has involved the family or representative of the resident. Where the assessment has been undertaken through care management arrangements the registered person has insisted on receiving a summary of the assessment and a copy of the plan. Briarfields DS0000020663.V296996.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Key standards 7.8.9.10.11 The medication at this home is well managed promoting good health. There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. The attitude of staff is excellent and service users are treated with dignity and respect. Personal and healthcare support in this home is offered in such a way as to promote and protect service users’ dignity and privacy in their daily life and at the end of life. EVIDENCE: All service users have a care plan. The home has effective systems in place to ensure the care plan is reviewed and updated monthly and arranges additional Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 11 reviews when changes take place. Service users confirmed they are able to participate and communicate their views to the development of the care plan and the review process. Feedback and involvement is a continuous ongoing process, staff spend time with individual service users to ensure they understand decisions and actions. Robust quality monitoring systems are in place. The manager had supervised a medication round on a unit and had assisted a service user with their personal care. The care plan is used as a working tool and is understood by all staff. This was demonstrated by a staff member going through one. It is written in clear language and can be used in an emergency by people who are not familiar with its content. Each care plan includes a comprehensive risk assessment. Management of risk takes into account the needs of service users balanced with their wishes for independence and choice. E.g. 2 residents had a lot of personal items in their room in bags and boxes, an assessment of hazard and risk had been conducted. Also one service user wished to do their own dressings and staff enabled this person to independently visit the surgery for supplies and carry out self-care. Staff supervise this discreetly and document the outcomes. The staff keep up to date with training, professional research and literature, in both the social care and clinical fields, and ensure that care plans are informed by the relevant social and clinical guidance. Each have information packs on specific topics, i.e. fire, infection control, medication. Records show that the home arranges for health professionals to visit frail service users in the home and provides facilities to carry out treatment Service users have choice over their personal care and are encouraged to be independent and responsible for their own personal hygiene where possible. The home operates an efficient medication system. Staff all have access to the written information and understand their role and responsibilities. Quality assurance systems confirm that policy is put into practice. Recently reported errors had been acted upon and procedures amended for improved safety. The need to respect service users’ privacy and dignity when delivering health and personal care is a key principle of the homes aims and objectives. Staff are aware that this also applies to all areas of the service users’ life. Service users are consulted and can decide which staff members they want to help them with their personal care. The staff group is balanced to enable choice of male, female and age related preferences. Service users were spoken with who had received care from a male carer that morning. They said that if they didn’t want this they could have a female member of staff but that the person had been professional and respected their dignity. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 12 The registered manager routinely observes staff attitude and approach to privacy and respect and constantly seeks and values service users’ views and experiences by working with them herself on occasions. Communication regarding end of life care is particularly strong as evidenced by a thank you sent to the manager after the death of a relative. The wishes of individual service users about dying and terminal care, and the arrangements they want after death are openly and sensitively discussed with both the residents and their family during the development of the care plan. An example of this was seen to be clearly recorded, respected and known to the staff delivering the care. The home has a detailed policy, procedure and practice guidance to help staff when handling terminal care and death. All staff receive in house training and practical advice in caring for these service users, and have continuous support and opportunities to discuss any areas of anxiety and concern. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Key standards 12.13.14.15 Staff have a good understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. Service users have many opportunities for community/family contact which enables them to make a choice about who they see and when and where they see them. Dietary needs of service users are very well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: The routines of the home are planned around the service users’ needs and wishes. Staff spoken with were very knowledgeable about individual likes and preferences for leisure time. The home encourages service users to take control of their life and be actively involved in the running of the home. Staff listen to service users and make considerable effort to provide a flexible service, which enables them to enjoy a better quality of life. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 14 Sufficient staff resources are provided to allow time for activities and stimulation. The home operates a key worker system, which enables closer service user staff relationships where likes, dislikes and needs are shared. Key workers use the information to plan activities which service users will enjoy. Staff spoken with were aware of their role and try to encourage residents to participate regardless of disability or age. The home has developed a system for displaying information and bringing attention to community events and activities. Service users said that their family and friends are made to feel welcome and know they can visit the home at any time. The home provides seating areas within the foyer where service users can entertain their visitors, in addition to the privacy of their own room. It is clear that the home encourages individuals and groups from the community to visit the home. This was seen in the arrangements for the Christmas period. The home is able to offer service users information and telephone numbers for contacting independent people who will act as advocates on the service users’ behalf where the service user prefers the help of an independent person. These were on display in the entrance hall. Service users have the choice to bring personal possessions with them on admission to the home and are encouraged to keep personal items which are important to them in their own room. Food and mealtimes are looked forward to. An experienced cook is responsible for providing quality nutritional meals that meet the dietary needs of the service users. The cook meets with service users, listen to their choices and suggestions for the menu, and encourage them to be adventurous and try new tastes as well as traditional foods. Tables are set attractively with the necessary cutlery and aids to help individuals during their meal. The home has the platinum healthy eating award. Service users stated that they like the flexibility of meal arrangements and enjoyed being able to eat in their own room if they wished. Regular drinks are available and service users said that staff will always make them a cup of tea at any time when asked. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Key standards 16.18 The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Staff are provided with induction and on-going training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: The service has a complaints procedure that is up to date, very clearly written, and is easy to understand. Service users said they would definitely talk to staff or the manager if they wanted to say anything negative. The complaints log showed that 7 complaints this year had been dealt with promptly and responded to within the agreed timescale. The policies and procedures regarding protection of service users are in place and are regularly reviewed and updated. The manager is clear when incidents need external input and who to refer the incident to. Training of staff in the area of protection is regularly arranged by the home. Service users stated that they are very satisfied with the service provision, feel Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 16 very safe and well supported by staff that have their protection and safety as a priority. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Key standards 19.26 The standard of the environment within this home is good providing service users with an attractive, homely and hygienic place to live. EVIDENCE: Briarfields provides a very well maintained, safe, comfortable, home. Areas for refurbishment are identified and plans put in place to deliver this. Many areas had been redecorated. Service users commented that they had a real choice of the room they live in. Couples who share a double room can remain on their own in that room, following a bereavement, until a suitable single room becomes available, and no new service user is admitted in to the room in the interim. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 18 The home is well lit, clean and tidy and smells fresh. The management has a proactive infection control policy and they work closely with external specialists, e.g. infection control, and their own staff to ensure that infections are minimised. Salient points from an audit by the Primary Care Trust have been implemented. The manager had also been involved in auditing some of the other CCSL homes. Clinical waste is properly managed and stored. Call bells were seen to be left within reach of service users and were noted to be responded to promptly. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Key standards 27.28.29.30 The standard of vetting and recruitment practices is excellent with appropriate checks being carried out. This ensures that suitable staff are employed to care for service users. The arrangements for the induction and training of staff are good with the staff demonstrating a clear understanding of their roles. There is a good match of well-qualified staff offering consistency of care within the home. EVIDENCE: The service has a very good recruitment procedure. The recruitment of good quality carers is seen as integral to the delivery of an excellent service. A recruitment file seen demonstrated that all safety checks had been conducted prior to the person starting. Induction is seen as being an extension of recruitment. Management prioritise training and facilitate staff members to undertake external qualifications beyond the basic requirements. NVQ2,3, and 4 are attended. The home has close to 75 of staff trained to NVQ 2. The manager has introduced internal developmental training, to complement formal training Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 20 as part of an ongoing training plan. The service encourages staff to share skills and knowledge with colleagues. Service users spoken with stated that staff are very caring, and are able to meet their needs. “They go over and above what should be done” Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Key standards 31.32.33.35.38 The home is managed by an experienced, suitably qualified individual who carries out her responsibilities fully. The manager has sound leadership skills and promotes a professional ethos within the home The manager continues to improve and make progress towards raising the standards in all areas for the benefit of service users. Health, safety and welfare of service users and staff are promoted fully by safe working systems in place Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 22 EVIDENCE: The registered manager has the required qualification and experience to run the home and meet its stated aims and objectives. The manager is visionary in her approach to the service and is able to demonstrate her experience and ability to care for older people, is aware of their conditions and diseases associated with old age. She implements the providers quality assurance systems and is involved in the dissemination of best practice within the home she manages and others. She has good ‘people skills’ and staff feel confident in her ability to lead them in their roles. Other professionals, such as district nurses have commented that the manager consistently provides high quality services. Staff have easy access to all documents, which are discussed during supervision, staff training and team meetings. Spot checks and quality monitoring systems provide management evidence that practice reflects the homes policies and procedures. The manager was conducting medication supervision on the day of the inspection. The provider is committed to ensuring the health, welfare and safety of residents and staff. Records are clearly written and up dated. The quality assurance system confirms that the findings from internal audits have been acted upon. From talking to service users, staff and management, there is strong evidence that the ethos of the home is open and transparent with the views of both staff and service users listened to, and valued. There is a detailed business and financial plan which gives a clear indicator of the success and efficiency of the business arrangements. The insurance cover in place ensures that the home is well able to fully meet any loss or legal liabilities. The home actively encourages service users who wish and are capable, to manage their own money and valuables, providing facilities to do this safely. The home has very efficient systems to ensure safe management of service users’ money including record keeping. Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 23 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 X X 3 Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 24 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. Refer to Standard Good Practice Recommendations Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Briarfields DS0000020663.V296996.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!