Inspection on 07/08/07 for Bryan Wood Care Home ta Southern Cross Healthcare

This inspection was carried out on 7th August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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Bryan Wood Care Home ta Southern... 19/09/06

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

CARE HOMES FOR OLDER PEOPLE Bryan Wood Care Home t/a Southern Cross Healthcare 1 Bryan Road Edgerton Huddersfield West Yorkshire HD2 2AL Lead Inspector Karen Summers Key Unannounced Inspection 09:00 7th August 2007 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 Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.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. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bryan Wood Care Home t/a Southern Cross Healthcare 1 Bryan Road Edgerton Huddersfield West Yorkshire HD2 2AL 01484 453366 01484 453344 bryan.wood@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Address 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) Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th September 2006 Brief Description of the Service: Bryan Wood is situated just off the Halifax Road in the Edgerton area of Huddersfield. It is approximately one and a half miles from the town centre and close to a small shop and a bus route. The home consists of a large house and two purpose built extensions. Inside there are three lounges and a dining room. Outside is a patio with seating for people who use the service and their guests. While the majority of people at Bryan Wood live there permanently the home also offers some short break accommodation. The provider informed the Commission for Social Care Inspection on 07/08/07 that fees range from £354.72 to £430 per week. Additional charges include hairdressing, private chiropody, newspapers, and toiletries. Information about the home and the services provided are available from the home in the statement of purpose and service user’s guide. People can also see a copy of the inspection report at the home. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit carried out to the home by an inspector on the 7th August 2007. The visit commenced at 9am and the inspector left the home at 4.30pm. There were 37 people in residence on the day. Mr Julian Shears manager was present throughout the visit and Mrs Lynn Walters Operations manager, was there for part of the day. During the visit the inspector spoke to people who live there, and a number of staff, read care records, staff recruitment records, training records and also had a tour of the home. To reflect the views of those who use the service, satisfaction surveys were sent to ten people living at the home, of which eight were returned, ten relatives/ advocate/ friends, four of which were returned, also to local doctors and health care workers (Social workers, community nurses), one of which were returned by the time of the inspection. Evidence used in the inspection process includes information supplied by the manager at the request of CSCI, about people who live at the home, staff who work there and how the home is run. Notifications received since the last inspection about incidents at the home have also been taken into account. The inspector would like to thank those who contributed to the inspection, and also thank Mr Shears, the staff and people who use the service, for their time and hospitality on the days of visits. What the service does well: People who were spoken with said that they had visited the home before deciding to move in, and without exception all surveys received from people who use the service said that they received enough information about the home before they decided to move in. Care plans were of a good standard and clearly identified the care needs, social interests and the likes and dislikes of the people using the service. There was evidence that people had been consulted and contributed to their care records, and there was also a section in the records to record when there had been any communication between relatives and the home. A survey received from a doctor stated that when the needs of a person are not met then Bryan Wood are always willing to re-assess and consider alternative management strategies/ alternative accommodation. The person also commented that, “This is an excellent home. If asked, I would have no hesitation in recommending it.” Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 6 There was also evidence that staff supports people who wish to self-administer their medication to ensure that their safety is maintained whilst maintaining their independence. There were a number of visitors visiting at the time, and the record in the visitors’ book confirmed that people visit the home at various times throughout the day. One of the visitors commented that she was always made to feel welcome and that her relative was enjoying her time at the home. A person who was having respite care also commented that she had enjoyed her stay at the home. She said that the food was very good, the staff lovely, and that she had no complaints. One of the relative’s surveys stated that the home provides a homely environment, and that the home is always clean and maintained. Another person said that people’s clothes and rooms are always clean. A survey from a doctor also said, “Very homely environment…” With the exception of one person the surveys from people who live at the home said that the home was always fresh and clean. The company together with input from relatives/ people who use the service has been successful in a bid for Government funding for improvements at the home. These improvements include a “Pier” (level access) to the front of the home, and a proposed architectural landscaped garden around the patio area. What has improved since the last inspection? What they could do better: To promote choice and ensure that the lifestyle of people living at the home matches their expectations, people must be consulted about the programme of activities arranged on their behalf and the activities that the person is involved in on a daily basis should be recorded to show that they have taken part. To comply with manufacturers instructions the room where medication is stored should not be above 26°C. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 7 The laundry floor should be resurfaced and sealed to ensure that it can be properly cleaned. 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. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 8 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 Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 9 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): 3 and 5 Standard 6 - the home does not take people who require intermediate care. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are assessed prior to them moving into the home and are able to visit the home to decide whether or not it is the right place for them. EVIDENCE: This home does not provide intermediate care. The care records of three people who use the service were examined, all of which contained a pre-admission assessment carried out by the funding local authority. Each assessment contained detailed information about the person’s current needs. In addition to this there was evidence that the home had also carried out an assessment of the persons needs. People who were spoken with said that they had visited the home before deciding to move in, and without exception all surveys received from people who use the service said that they received enough information about the home before they decided to move in. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 -10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The level of care people need, which includes their health, personal and social care needs are clearly highlighted within their care plan. People are treated with respect. EVIDENCE: Care plans were of a good standard and clearly identified the care needs, social interests and the likes and dislikes of the people using the service. There was evidence that they had been consulted and contributed to their care records, and there was also a section in the records to record when there had been any communication between relatives and the home. Since the last inspection the recording in the daily record has improved and now reflects the care that has been provided for individual people who live at the home. One relative commented in the survey that the care home meets the needs of their relative, and three people said that the home usually meets the needs of their relatives. One person said that it depends on the staff, as some are better Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 11 than others. The same person said that on one occasion they were not informed when their relative went for a hospital appointment. The other surveys confirmed that they were always kept up to date about important issues. A survey received from a doctor stated that when the needs of a person are not met then Bryan Wood are always willing to re-assess and consider alternative management strategies/ alternative accommodation. The person also commented that, “This is an excellent home. If asked, I would have no hesitation in recommending it.” The medication and records of three people were inspected and found to be correct. There was also evidence that staff supports people who wish to selfadminister their medication, and that an assessment of any risks is reviewed. A survey from a doctor confirmed that the home supports individuals to administer their own medication or manage it correctly where this is not possible. There was also evidence that staff that administer medication have had training and the staff that were spoken with on the day also confirmed this. The temperature of the medication room had been recorded daily and recording were 28 and 29° C on more that one occasion. As discussed on the day the temperature of the storage of medication should not be above 26° C, and Mr Shears agreed to monitor the situation and take action where necessary. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to maintain contact with their family and friends, and staff assist people in having a choice in most things they do. Meals are varied and nutritious. There was limited documented evidence to suggest that the lifestyles experienced in the home matches people’s expectations in relation to their social and recreational interests and needs. EVIDENCE: At the time of the visit people were been assisted to one of the day rooms in readiness for the hairdressers arrival. Once the hairdresser had arrived the activities coordinator assisted in washing peoples hair. One of the people who were spoken with said that she chooses to have her hair set weekly and that she looked forward to the event. In between the hairdressing, for those people who wished the activities person was filing and caring for their nails. The people’s social record was filled in on an ad hoc basis, although the activities person had recorded when she had carried out an activity in the individual’s daily record, and a weekly list of activities was seen which included trips out of the home, visits from entertainers, and every other Tuesday the home has a luncheon club where one or two people from the community visit the home. In addition to the activities programme there is a four weekly newsletter informing people on matters of interest. Personal newspapers are delivered on Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 13 request. The people who were spoken with said that not a lot goes on, and one relatives survey commented that more activities are needed for very elderly residents. Another relative commented that although there relative is active the home promotes an inactive lifestyle. Four surveys from people who live at the home commented that there are always activities they can take part in, two said usually, one person said that it was not their scene, and one person said that there were sometimes activities that they can take part in. There were a number of visitors visiting at the time, and the record in the visitors’ book confirmed that people visit the home at various times throughout the day. One of the visitors commented that she was always made to feel welcome and that her relative was enjoying her time at the home. A person who was having respite care also commented that she had enjoyed her stay at the home. She said that the food was very good, the staff lovely, and that she had no complaints. Surveys received from five people who live at the home said that they usually like the meals at the home and three said that they always liked the meals. A relatives survey said, “Meals are very good, well balanced diet.” And another relative commented that, “the meals are varied and nutritious.” One person said that staff know that their relative does not eat pork but due to an issue with communication the person received a ham sandwich. Two out of four relative surveys said that the care service meet the different needs of people and two said usually. A survey from a doctor also said that the care service respond to the different needs of individuals. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, and people who use the service and their relatives are confident appropriate action will be taken to address any issues. Staff receive safeguarding training, (protection of vulnerable adults training,) which helps to protect the people from harm. EVIDENCE: The complaints procedure was located in the reception of the home and with the exception of one relative, the surveys received from people who live at the home and their relatives said that they knew how to make a complaint and who to complain to. One of the relatives and people who use the service when spoken with also said that if they had any concerns they would speak with the manager. The home has the up to date Kirklees Safeguarding Policy, and the home’s complaints procedure had also been updated to reflect that policy. Training records showed that staff have had safeguarding training (protection of vulnerable adults training,) and when spoken with staff were aware of the procedure to follow. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People who use the service live in a homely, clean and well-maintained environment. EVIDENCE: As part of the inspection a tour of the home was conducted which included the communal areas, a number of peoples bedrooms, and the laundry. Since the last inspection the home has undergone a redecorated programme and a number of areas had been tastefully redecorated. One of the relative’s surveys stated that the home provides a homely environment, and that the home is always clean and maintained. Another person said that people’s clothes and rooms are always clean. A survey from a doctor also said, “Very homely environment…” With the exception of one person the surveys from people who live at the home said that the home was always fresh and clean. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 16 As discussed on the day the laundry floor should be resurfaced and sealed to ensure that it can be properly cleaned. The company together with input from relatives/ people who use the service has been successful in a bid for Government funding for improvements at the home. These improvements include a “Pier” (level access) to the front of the home, and a proposed architectural landscaped garden around the patio area. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. There are sufficient numbers of staff to meet peoples’ needs. Staff receive training to assist them to carry out their responsibilities and they have had all the necessary checks before working with people so that they are kept safe. EVIDENCE: The staff duty rotas were looked at, and staff were spoken with and there was evidence to suggest that staffing levels and skill mix were sufficient to meet the number and needs of people living there. Five surveys received from people who live at the home commented that there is always staff available when you need them. One person said usually and one said sometimes. When spoken with people said that staff were always available when they were needed. A survey from a doctor said that staff are good and individuals are allowed to be themselves. A person living at the home said, “I am happy living here.” Evidence was seen to suggest that staff are encouraged to have an NVQ level 2 in care, and Mr Shears confirmed that sixty percent of care staff have the qualification. Staff recruitment files contained the relevant information and documentation. Evidence was seen in the staff records and staff also confirmed that they had induction training. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to the service. People benefit from the management approach of the home and the manager ensures so far as is practicable that the health, safety and welfare of people and staff are protected. The home is run in the best interest of people who live there, and their finances are safeguarded. EVIDENCE: Mr Shears the manager has much year experience in the care of older people, and has gained the Registered Managers Award and is also a National Vocational Assessor. The manager has an open door policy and also a notice was seen on the entrance notice board encouraging relatives/ visitors to see him if they would like to discuss any issues. Regular meeting have also been held with relatives/ Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 19 advocates and minutes were seen displayed in the home, and the manager said that copies are also sent to the people who attended. The issues discussed included improvements to décor, ideas about activities etc. Mr Shears said that her is planning for the future to hold the meeting every other month. Mrs Walters Operations manager, said that the quality assurance surveys are sent out every year and the outcome of those surveys are presented to the people who use the service and their relatives/ advocated by the manager. Mr Shears said that he also plans to publish the results of the next surveys in the “Bugle” (newsletter). Personal allowances and the resident’s fund are checked weekly for accuracy, and they are stored correctly, and there was evidence to suggest that receipts are given for any transactions. There were also facilities to deposit monies out of office hours. Even though the situation was said to have not arisen, discussion was held should a person wish to have access to their monies out of office hours. Mr Shears and Mrs Walters confirmed that this facility would be made available. Satisfactory records were seen for fire alarms and emergency lighting. There was also evidence to suggest that all staff have had fire drills/ lectures and movement and handling training and staff also confirmed this. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 21 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. 1. Standard OP12 Regulation 16(2)(n) Requirement People must be consulted about the programme of activities arranged on their behalf and take into consideration their needs. This will ensure that the activities match the expectations and needs of the people living at the home. Timescale for action 07/09/07 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. 2. 3. 4. Refer to Standard OP9 OP12 OP26 OP35 Good Practice Recommendations The temperature of the drug administration storage room should not go above 26°C The activities that the person is involved in on a daily basis should be recorded to show that they have taken part. The laundry floor should be resurfaced and sealed to ensure that it can be properly cleaned. There should be the facility for people who live at the DS0000065973.V343157.R01.S.doc Version 5.2 Page 22 Bryan Wood Care Home t/a Southern Cross Healthcare home to have access to their monies out of office hours. Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Bryan Wood Care Home t/a Southern Cross Healthcare DS0000065973.V343157.R01.S.doc Version 5.2 Page 24 - 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. 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