Inspection on 20/05/05 for Bromley Road, 22a

This inspection was carried out on 20th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bromley Road, 22a 21/01/08

Bromley Road, 22a 16/08/07

Bromley Road, 22a 12/07/06

Bromley Road, 22a 18/01/06

Bromley Road, 22a 16/12/04

Bromley Road, 22a 27/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Townley Road, 2-3

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 22a Bromley Road Catford London SE6 2PT Lead Inspector Rossella Volpi Unannounced 20 May 2005 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 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 Stationary 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. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 22a Bromley Road Address Catford London SE6 2PT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8690 6681 020 8314 0300 Mpower Limited Mrs Donna Esther Brodie-Brown CRH care home PC care home only 11 Category(ies) of LD Learning Disability registration, with number LD(E) Learning Disability - over 65 years of places MD Mental Disorder MD(E) Mental Disorder - over 65 years 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for 11 persons of whom 11 can have a learning disability 2 3 6 can have a mental disorder 2 of the service users may be over the age of 65 years Date of last inspection 16 December 2004 Brief Description of the Service: 22 Bromley Road is a care home for a maximum of eight women and men with mild to moderate learning disabilities, who might also have other support needs, such as, for example, certain mental health needs or physical impairments. The overall aim is that of providing care and to empower service users to make informed decisions, leading to fulfilling experiences. The philosophy is that of enabling ordinary living as members of the community, with equal rights and access to employment, training, recreation, housing, health and social services. 22 Bromley Road aims to achieve this by ensuring that the service would be based on a thorough assessment of needs and delivered in collaboration with external agencies. Recruitment and training would be targeted to enable staff to advance the rights to privacy, dignity, independence, security, civil rights, choice. The provider is an organisation named: ‘Mpower Ltd’. represented by one of its directors. The day-to-day running of the home is delegated to a care manager.The premises are a large detached house, set back from a busy main road, with a large garden. Recent building work extended the house to provide eleven single bedrooms, 3 with en-suite facilities and to make part of the premises suitable for people using wheelchairs. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and consisted of one visit conducted on 20 May 2005, during the afternoon. The findings were informed by general observations, discussion with two residents, discussion with one of the two deputy managers, brief discussion with the other deputy and inspection of records. The focus of this inspection was: To follow up on requirements or recommendations from the previous inspections. To inspect the premises following the extensive building work, that had been undertaken over the past year to extend the house. Some requirements or recommendations from the previous inspection could not be properly followed up because the manager, who had been away for a while, was the main person working on them. Additionally the time scales for some had not yet expired. However, the deputy confirmed that action had been initiated on all. Those requirements are therefore stated again with the same or with a new time scale. What the service does well: The home had a clear ethos of valuing residents and the residents confirmed that they were well supported by a committed staff group. Examples of some comments were that: staff are nice and have time to spend with residents; that the proprietor always asks for the resident’s views when he visits; that the resident likes swimming and cooking and could do this; that the resident was able to come and see the home many times and was given the information needed to decided that Bromley Road was the preferred home. Residents were aware of their care plans and it was evident that they had contributed to it. A feeling of safety was expressed and of confidence in the management and staff team to deal with any issues that might impinge on safety or well being. There was a range of activities in which the residents were involved, both in and outside the home, which reflected individual preferences and choices. Family contacts were supported and encouraged The home worked in partnership with the specialist health professionals to ensure that health needs would be met. Residents considered the premises comfortable and meeting their needs 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 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. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 Prospective residents’ needs and aspirations were assessed, so that a service tailored to their needs could be provided. Residents were informed about what could be expected from the home. Some essential documents were yet to be completed, to offer residents a better opportunity to consider whether the service at Bromley Road would be their preferred option for meeting their support needs. EVIDENCE: One resident discussed how the process of admission had been carried out and confirmed that he was able to visit and spend enough time at the home to decide that he wanted to live there. The deputy confirmed that any new admission to the home would only be conducted after a thorough consideration of the placing authority’s assessment. The home did not take emergency admissions. The residents discussed some of the specialist health services received; this was consistent with the information from records and from staff. It continued, therefore, to be evident that the home worked in partnership with residents and external professionals to meet users’ assessed needs. Care plans seen showed evidence of reviews. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 9 As discussed at the previous inspection, the revised statement of purpose was informative, but needed more details regarding staffing and the provider’s assessment of staffing needs. Individual contracts were to be revised. A service users’ guide, appropriate to the needs of the residents, was to be completed, although much of the information to be included in such guide was available in other documents. The deputy manager assured that work on all the above was being undertaken. (The time scales were not yet expired and the requirements or recommendations are therefore repeated). 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 (A judgement could not be made as no outcomes were assessed, although there were previous recommendations that are re-stated) EVIDENCE: The recommendations from the previous inspection are repeated. It was not possible to check, on this occasion, whether they had been implemented or not, due to the manager and provider (the lead people on this work) not being present, as this was an unannounced inspection. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17 Residents were supported in maintaining independence and in achieving a fulfilling lifestyle in and outside the home, so that they would have opportunity for personal development and inclusion in the community, consistent with their aspirations, cultural and spiritual needs. EVIDENCE: 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 12 Residents spoke about the range of activities, which they had chosen, with staff support, according to their individual preferences. They showed satisfaction with the way staff informed them and helped them to make decisions, outlining choices and consequences. Residents and staff gave examples of ways in which residents were supported in taking responsibility in their daily life, including assessing risks and how to minimise them. A resident spoke in some detail about the family and friendship links she and other residents were supported in maintaining. She said that she was able to receive visitors in private and to mix with people not resident at the home. Discussion with the deputy and inspection of files confirmed that staff supported residents to have appropriate family, personal and sexual relationships. One resident and staff confirmed that residents could cook their own meals, or could eat the communal meals, which they planned and helped prepare (usually on a rota basis). This was also observed. From discussion of menus, it was evident that healthy eating was encouraged and consideration was given to personal and cultural preferences. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19,20 Residents received personal and emotional support in a way that they considered reliable and responsive to their needs. Their health care needs were assessed and recognised. Action had been taken, but not yet all completed, to comply with previous requirements regarding medications. EVIDENCE: Residents and the deputy confirmed that same sex care would be made available, if preferred or appropriate. Residents were satisfied with the way staff respected their privacy and supported them with personal care tasks. Files and staff confirmed that residents were registered with a local general practitioner (GP) and were encouraged to go for dental, eye and other health checks as necessary. Staff at the home worked with the multi-disciplinary team involved in each resident’s care. Residents spoke of the specialist help received, The deputy discussed progress made in complying with previous requirements on the area of medications. This had been considered overall satisfactory at the previous inspection, subject to the home addressing some identified issues. Those regarding staff training and additions to the medication policy were still to be completed and a new time scale was agreed with the deputy. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Residents felt safe at the home and able to speak to staff, so that they could feel confident that their views would be taken seriously. Management was aware that the complaints’ procedure had not been used much, but was taking action to support residents in expressing their views and eliciting their comments. EVIDENCE: Residents said that they felt safe at the home and able to complain. From direct observation, there was evidence that residents interacted easily with staff. There was a variety of ways to encourage comments from residents, including monthly visits from the provider and one resident said that their views were sought. The home had an adult protection procedure, including whistle blowing. The deputy confirmed that staff had been attending training in prevention of abuse, organised by Lewisham social services. He also said that the manager had given a copy of the home’s procedure on adult protection to all placing authorities and invited their comments. The deputy said that the recommendation regarding access to internet and electronic mail was being considered by the directors. The deputy considered that the residents were protected. However, it was not possible to discuss with the manager her appraisal of the current situation, on this occasion. Because of this and because of a still to be resolved incident between two residents, which was the subject of an adult 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 15 protection investigation, the standard of almost met, as given at the previous inspection, remains. (Standard 39 has some bearing on this area also). It was positive that management had responded promptly when the need was identified for additional staffing, to help prevent harm to individual residents or to minimise potential risks to others in the home. Inspection of one file and discussion with the deputy gave evidence that the procedure put in place to manage a specific behaviour, to protect another resident, had been agreed with the placing authority of the residents involved and a review date had been set. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,30 Residents lived in a home that they found comfortable and where they could personalise their space. A lot of work had been done to render the premises more suitable to residents’ changing needs. Attempts had been made to embellish the environment to create a homely feel. EVIDENCE: 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 17 The resident who conducted the tour of the house showed evident satisfaction with her room and with the premises. Both she and another resident, who had more recently come to live there, said that the facilities met their needs. Both rooms had been personalised and decorated according to their occupants’ choice. The premises were generally bright, clean and spacious. The building extension work, which had protracted for over one year, had been completed. The extension had increased the number of bedrooms to eleven (all single rooms); three of these with en-suite facilities, while part of the premises had been made suitable for people using wheelchairs. The home had a range of communal space available for the service users. These included a large garden, sitting room, a leisure room with computer and seating and dining room. The main kitchen was to be refurbished. However, some remedial work had been carried out and the latest environmental health report assessed the kitchen as satisfactory. An additional, smaller, kitchen had been installed. There was a policy in place to control the spread of infection. The laundry was located separately from the kitchen and washing and drying machines had the necessary wash cycles to ensure that hygiene could be maintained. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none (A judgement could not be made as no outcomes were inspected, although there were previous requirements that are re-stated) EVIDENCE: The requirements from the previous inspection are restated, with a new time scale, as it could not be ascertained, in the absence of the manager, whether they had been complied with or not. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39 Management continued to take steps to ensure that residents would benefit from a well run home, so that residents and staff would feel valued and included in all aspects of its conduct. EVIDENCE: 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 20 Residents and staff were positive about the managent of the home, that was considered to be suppotive, committed to equality and trying to convey a clear ethos of valuing residents’ individuality. The deputy confirmed that the provider and manager were strengthening or consolidating quality assurance systems. This could not be fully followed up on this occasion, as the manager was not there. The previous requirement therefore continues, although there was evidence that some action had been taken. The manager had been assessed as suitable for the position by the provider and the registration authority. She had been taking steps to comply with the requirement for managers to be appropriately qualified, to level 4 NVQ (or equivalent), in care and management by 2005. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 2 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 22a Bromley Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x x x G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 Requirement Each service user to be provided with a service users’ guide to the home. The information to be up to date and to include all that is required by the relevant standards and regulations. Contracts/statements of terms and conditions between the home and each service user need to: - Include a copy of the service user’s plan. - Include the arrangements for reviewing needs and progress and updating the service user’s plan. - Be given to each service user or, if not appropriate to do so, be accessible to each service user at any reasonable time. The medication policy to include: i) A section for leave medication. This must ensure that: - there is a documented process for making certain that users are issued with medication, to be used while away from the home - there is a process to ensure medication is checked out and back into stock on their return. G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Timescale for action 1 August 2005 2. 5 5 1 August 2005 3. 20 13 1 August 2005 22a Bromley Road Version 1.30 Page 23 ii) A statement that medication must be retained for 7 days in the event of the death of a service-user. (Previous timescale, of 1 May 2005, not complied with. New timescale agreed). All care-staff, who administer or handle medication, to have formal training in medication use, control and administration. (Previous timescale, of 1 May 2005, not complied with. New timescale agreed). An action plan detailing when the refurbishment of the main kitchen will be undertaken and the arrangement for the safety of the service users during the work. The provider to state the range of skills and qualifications or training, considered necessary in the staff team, to meet service users needs. (Previous timescale, of 1 April 2005 extended). 7. 34 19 As part of the vetting procedures for assessing suitability of staff, all previous work and education history to be obtained and any gaps explored. (Previous timescale, of 1 February 2005 extended). The quality assurance systems for the service to be developed. An effective system to be achieved where service users’ views underpin all selfmonitoring, reviews and development of the home. 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 24 4. 20 13 1 August 2005 5. 28 16 1 December 2005 (for action plan) 1 August 2005 6. 32 18 1 August 2005 8. 39 24 1 October 2005 (Previous timescale, of 1 April 2005 extended). 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 1 Good Practice Recommendations That when the statement of purpose is next updated, it incorporates the provider’s assessment of the expertise and qualifications he considers the staff team should have, to meet the needs of the service users. This should then be consistent with the recruitment and training plan for the home and associated policies. That the contracts between the home and service users are discussed with the service user, their advocates and the home’s legal consultant. This would be to ensure that contracts include all the necessary information, that they legally protect service users’ rights, that they clearly state the respective rights and responsibilities of the user and the provider. That the key worker sessions be structured and fully recorded. That the home reviews its confidentiality policy. In relation to staff working at the home, that the policy includes who would have access to what, on a need to know basis. That the home issues a statement on confidentiality to its partner agencies, setting out the principles governing the sharing of information. That the provider arranges internet access and electronic mail facilities. (This would be to enable staff to more easily access the relevant extracts of the placing authorities’ adult protection procedures and facilitate fast and recorded communication). That, as part of the recruitment procedure for staff, when photocopies are made of original documents, a note is made in the staff file that the original was seen. That the provider produces a business plan for the home. 2. 5 3. 4. 5. 6. 8 10 10 23 7. 8. 9. 34 43 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 46 Loman Street London SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 22a Bromley Road G52-G02 S25612 22BromleyRoad V232632 200505 stage 4.doc Version 1.30 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!