Inspection on 31/10/05 for Brooklands

This inspection was carried out on 31st October 2005.

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

Brooklands 10/06/08

Brooklands 17/07/07

Brooklands 04/07/06

Brooklands 07/02/06

Brooklands 17/11/04

Brooklands 12/05/04

Brooklands 04/11/02

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Brooklands Wych Cross Forest Row East Sussex RH18 5JN Lead Inspector Niki Palmer Unannounced Inspection 31st October 2005 11:15 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 Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 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. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brooklands Address Wych Cross Forest Row East Sussex RH18 5JN 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) 01825-712005 Mr Hadi Rajabali Mrs Shehnaz Rajabali Mrs Catherine Esther Sheil Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (29) of places Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated at any one time is twenty nine (29) That the care home provides general nursing care to older people aged sixty five (65) years or over on admission and can provide care to people with a physical disability 17th November 2004 Date of last inspection Brief Description of the Service: Brooklands Nursing Home is registered to provide general nursing care for 29 residents and admits those who are either privately funded or funded by Social Services. The home is situated on the A22 at Wych Cross, approximately three miles south of Forest Row village. It is an old building that has been converted for its current purpose. Building extensions have been tastefully added to keep the atmosphere of the older building. The home comprises of 25 single and two double bedrooms. All except for two of the rooms have en-suite facilities. Rooms are located over two floors, accessible by a passenger shaft lift. There are extensive attractive gardens to all sides of the property that are accessible to residents when the weather permits. Due to the rural location of the home, there are no local amenities within easy access of the home. No public transport is accessible, except for taxis. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Brooklands Nursing Home will be referred to as ‘residents’. This unannounced inspection took place on a Monday between 11.15am and 5.45pm. The inspection began with discussions with the Registered Manager of the care home in respect of progress made since the last inspection, followed by the examination of five care records. In order to gather evidence on how the home is performing, individual discussions took place with eight residents, one Registered Nurse, three care staff and five visiting relatives. 27 residents were accommodated at the time of the inspection. Other areas and documentation inspected included: the home’s medication systems, complaints and adult protection procedures, staff training records, recruitment files, staff induction programme and quality assurance systems. What the service does well: What has improved since the last inspection? It was pleasing to note that since the last inspection care planning procedures have improved. All plans of care are now shared with residents and / or their relatives and are updated on a regular basis. In addition the home has purchased new weighing scales. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 6 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. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 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 Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Sufficient information is available for prospective residents and their relatives in order to help them make a decision of where to live. Adequate systems are in place to ensure that residents’ needs are assessed prior to admission. EVIDENCE: All of the residents and relatives spoken with said that either a friend or General Practitioner had initially recommended the home to them. Residents also confirmed that either they or their relatives had the opportunity to meet with the Registered Manager and look around the home, prior to making a final decision to move in. A detailed Statement of Purpose and Service Users’ Guide is in place, which is available on request. These contain details of the structural organisation, services and activities provided by the home, terms and conditions of residence, residents’ charter, the accommodation provided, catering arrangements and a copy of the home’s complaints procedure. A copy of the home’s most recent inspection report is also available on request. The home updated its pre-admission assessment form in response to a complaint investigation carried out by the CSCI in April 2005. Three completed Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 9 assessments were seen on the day of inspection, all of which had been undertaken by a Registered Nurse prior to admission. They were all found to contain sufficient information in relation to medical history, personal care needs, baseline observations (pulse and blood pressure), medication and mental state and cognition. It is recommended that the home includes personal preferences, likes and dislikes within the initial assessment and that those present at the time of the inspection are noted. Intermediate care is not provided. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, and 9. The health care needs of residents are mostly met by the home with regular multidisciplinary working taking place, however the systems for the administration and storage of medication need to be improved. EVIDENCE: Three plans of care were seen on the day of inspection. It was pleasing to note that since the last inspection, residents and/or their relatives are asked to sign the care plan in order to evidence that they are in agreement with the proposed care. All plans were found to contain sufficient information for staff to follow. In addition, detailed guidance in relation to manual handling and meeting personal care needs is available for quick reference in individual bathrooms. The nurse in charge maintains daily records for each resident. The home needs to ensure that residents’ psychological health is monitored and that clear information is included within the plans of care for staff to follow. Pressure relieving equipment is in place for all residents who are assessed as being at risk and turning charts are kept in each of the bedrooms, with clear information and guidance for care staff to follow. Input from a tissue viability Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 11 nurse is sought as necessary. In addition, it was pleasing to note that fluid balance charts and guidance for staff were prominent in some residents’ bedrooms. Although risk assessments are carried out for the prevention of falls by the nurse in charge, it is required that they provide clear actions for staff to follow in order to prevent any assessed risks in accordance with guidelines devised by the Department of Health for the prevention of falls in older people (NICE). Records of medical intervention showed that the home works closely with health care professionals including GP’s, community nurses and chiropodists. This is to ensure that residents receive the necessary health care intervention. Residents spoken with said that when they have asked to see a doctor then this has been sought promptly. The home’s medication procedures were viewed. A pre packed medication system is used, which can be easily monitored. It was concerning to note that the medication trolley on the ground floor was not secured. This was addressed with the nurse in charge at the time of the inspection. All controlled drugs are stored in the clinical room appropriately. The home is required to ensure that all controlled drugs no longer prescribed and those that have been returned to the pharmacy are recorded within the controlled drugs register with immediate effect. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13. Opportunities for stimulating leisure activities need to be improved to provide a more interesting lifestyle for the residents accommodated. Links with friends and families are valued and supported well by the home. EVIDENCE: Exercise groups take place every other Wednesday, however many of the residents spoken with said that since the activities person left, there are few opportunities to engage in stimulating pursuits and said that they are often bored. Many residents choose to stay in their rooms and watch television, listen to the radio or read books. The Registered Manager confirmed that the home is trying to recruit a new activities coordinator. All of the visitors spoken with said how welcomed they are made to feel during their stay and that they are able to visit at any reasonable time. In addition they confirmed that they are kept informed of any changes to their relatives needs and felt able to approach any member of staff with any concerns or queries they had, particularly the Registered Manager. Many residents have their own telephone line in their rooms and confirmed that they are able to maintain regular contact with friends / relatives who are unable to visit on a regular basis. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. A lack of procedural guidance is in place to advise staff in respect of safeguarding residents from harm. Both this and the home’s recruitment practices have the potential to place residents at risk. EVIDENCE: Brooklands has an adequate complaints procedure in place, which includes details of how the Commission for Social Care Inspection (CSCI) can be contacted. A complaint was received by the Commission for Social Care Inspection in April 2005. Concerns were raised in respect of the home’s preadmission procedure, risk assessments and the home’s policies and procedures regarding maintaining fluid balance. This complaint was upheld and requirements made. All concerns have been followed up during this inspection and are detailed throughout the report. Although the home has an adult protection policy in place, which clearly defines what constitutes abuse, a clear procedure for reporting suspected abuse, needs to be implemented in accordance with local multi-agency guidelines. This must include details of PoVA (the protection of vulnerable adults). In addition, the home’s whistle-blowing policy needs to include details of how to contact the CSCI and the procedure that will be followed where concerns are raised. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26. Brooklands Nursing Home provides residents with a warm, comfortable and homely place to live. EVIDENCE: An inspection of the premises on the day of the inspection confirmed that the home is well-maintained throughout and suitable for its stated purpose. Many of the residents and visitors to the home said that the overall environment was a contributory factor in making a final decision to move in to the home. Some specialist equipment is available for residents throughout the home and new weighing scales have been purchased. The home has not been assessed by a qualified Occupational Therapist since the last inspection report. This remains an outstanding recommendation. All residents are provided with their own bedrooms, most of which have ensuite facilities. Residents are encouraged to bring their own personal belongings and furniture with them to the home. A small number of rooms Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 15 were viewed, all of which were found to be personalised to individual preferences and taste. The owners of the home have recently carried out a maintenance check of furniture within the home and identified what needs replacing. The home has only 10 height adjustable beds. It is an outstanding requirement for the home to prioritise and implement a programme for providing adjustable beds. This will be an ongoing programme. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Although the home is adequately staffed, poor judgements are being made regarding the manner in which staff are deployed to work in the home. These continue to place residents at a high level of risk. EVIDENCE: Staffing rotas seen on the day of inspection and residents and visitors spoken with confirmed that the home is adequately staffed to meet the assessed needs of residents. A total of six Registered Nurses, 16 care assistants and seven domestic staff are employed at Brooklands. Of the 16 carers, only 2 are trained to at least NVQ level 2 in care. Discussions took place with the Registered Manager of the home in respect of those employed from overseas who are qualified nurses in their own country. A recommendation has been made for the home to clarify with the relevant organisations, their status in regard to NVQ. The Registered Manager informed the Inspector that three new staff had recently been deployed to work in the home, all of which were from overseas. All three of the recruitment files seen contained photo identification, two written references, their status to work in the UK, a health declaration and a recent police clearance from their own countries, however it was concerning to note that a thorough detailed history of employment, or gaps in employment had not been accounted for. Requirements have been made in respect of this. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 17 One of the files did contain evidence of a PoVA First and Criminal Record Bureau check (CRB), however this had been applied for by a previous employer. It was reinforced to the Registered Manager that CRB’s are not portable. In addition, through speaking with staff, it emerged that another carer had been employed to work in the home within the last two weeks and a self-employed hairdresser. Neither were in receipt of a PoVA First or Criminal Record Bureau check. In depth discussions took place with the Registered Manager regarding thorough recruitment checks and immediate requirements issued. Written information was also provided by the Inspector. The home currently has a very brief induction checklist. A recommendation has been made for the Registered Manager to consult with their professional body in respect of the new Common Induction Standards issued by Skills for Care (replacing TOPPS). Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 36. Albeit that residents and their relatives express satisfaction with the overall care and management at Brooklands, there is little evidence that their interests are safeguarded in respect of recruitment, and lack of procedural guidance for staff. EVIDENCE: At the last inspection, the Registered Manager said that a new quality assurance and quality monitoring programme had been developed and that the home proposes to seek the views of residents / relatives / health professionals twice per year. On the day of this inspection the most recent resident feedback forms were dated February 2004. A requirement has been made in respect of this. It was pleasing to note that since the last inspection the Registered Providers of the home are visiting the home regularly and carrying out interviews with Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 19 staff and residents and an inspection of the premises in accordance with Regulation 26. It is an outstanding requirement that details of these reports are forwarded to the CSCI. Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 20 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 4 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X 3 X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X 2 X X Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 13(1)(b) Requirement It is required that residents’ psychological well-being is monitored and detailed within the plans of care. It is required that the home amends its falls risk assessment in accordance with guidelines produced by the Department of Health (NICE). All risk assessments must detail the action that is to be followed in order to prevent the potential risks. It is required that medicine trolleys are secure at all times [IMMEDIATE REQUIREMENT]. It is required that controlled drugs no longer prescribed are recorded on the controlled drugs register [IMMEDIATE REQUIREMENT]. It is required that all medicines that have been returned to the pharmacy are recorded [IMMEDIATE REQUIREMENT]. It is required that residents are offered a variety of stimulating and meaningful activities. It is required for the home to DS0000013968.V254349.R01.S.doc Timescale for action 31/10/05 2. OP8 13(4)(b) (c) 31/01/06 3. 4. OP9 OP9 13(2) 17(1)(a) Sch 3 13(2) 17(1)(a) Sch 3 13(2) 17(1)(a) Sch 3 16(2)(m) (n) 12(1)(a) 31/10/05 31/10/05 5. OP9 31/10/05 6. 7. OP12 OP18 31/01/06 31/01/06 Page 22 Brooklands Version 5.0 13(6) 8. OP18 13(6) 9. OP24 16(1) 16(2)(c) 10. OP29 19 and Schedule 2 11. OP29 19 and Schedule 2 19 and Schedule 2 12. OP29 13. OP33 24 implement a clear procedure for staff to follow in the event of suspecting abuse. This must be in accordance with local multiagency guidelines and include details of PoVA [THIS IS OUTSTANDING FROM THE PREVIOUS REPORT]. It is required that the home’s whistle-blowing policy includes the contact details of the CSCI and the procedure that will be followed where concerns are raised [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION REPORT]. It is required that the home prioritises and implements a programme for providing height adjustable beds [OUTSTANDING FROM TWO PREVIOUS INSPECTION REPORTS]. This will be an ongoing programme. It is required that all staff who commenced work after 26th July 2004 are in receipt of an up to date PoVA First and CRB check. This must be applied for by the home. It is required that a full employment history including any gaps in employment is accounted for. It is required that the Registered Manager familiarises herself with the new implemented procedures regarding the recruitment of staff and ensures that no new staff are employed to work at the home without thorough recruitment checks [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION REPORT – IMMEDIATE REQUIREMENT ISSUED]. It is required that the home obtains feedback from residents / relatives/ health professionals. DS0000013968.V254349.R01.S.doc 31/01/06 31/05/06 31/12/05 31/10/05 31/10/05 31/05/06 Brooklands Version 5.0 Page 23 14. OP36 26 These survey results should be analysed and made available to residents, the CSCI and any other interested parties [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION REPORT] It is required that the Registered 31/10/05 Provider forwards copies of Regulation 26 visits to the CSCI. [THIS IS OUTSTANDING FROM THE TWO PREVIOUS INSPECTION REPORTS]. 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 OP3 Good Practice Recommendations It is recommended that personal preferences, likes and dislikes are recorded within the initial pre-admission assessment and that those present at the time of inspection are noted. It is recommended that the home is assessed by a qualified Occupational Therapist [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION REPORT]. It is recommended that 50 of care staff are trained to at least NVQ level 2 in care by December 2005. It is recommended that the NVQ status of staff employed from overseas is clarified with the relevant organisations. It is recommended that the current application form is reviewed and amended to allow for a thorough detailed history of employment, including any gaps. It is recommended that the Registered Manager consult with their professional body in respect of the new Common Induction Standards issued by Skills for Care (replacing TOPPS). 2. 3. 4. 5. 6. OP22 OP28 OP28 OP29 OP30 Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Brooklands DS0000013968.V254349.R01.S.doc Version 5.0 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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