Inspection on 19/04/05 for Burgess House (Flat A)

This inspection was carried out on 19th April 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Burgess House (Flat A) 17/08/07

Burgess House (Flat A) 09/05/06

Burgess House (Flat A) 08/12/05

Burgess House (Flat A) 12/10/04

Burgess House (Flat A) 15/04/04

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Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Burgess House Flat A 3 Blyth Road Bromley Kent BR2 9QT Lead Inspector Wendy Owen Unannounced 19th April 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. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Burgess House Address Flat A, 3 Blyth Road, Bromley, Kent . BR2 9QT 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 8460 0636 020 8460 0957 Bromley Autistic Trust Vacant CRH 4 Category(ies) of LD 4 registration, with number of places Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12th October 2004 Brief Description of the Service: Burgess House is owned by Kelsey Housing and leased to the Bromley Autistic Trust. The premise comprises four flats. The ground floor flat (the home) is the registered establishment. The remaining flats are leased to tenants.The home is registered to provide care to four adults between the ages of 18 and 65, with learning disabilities, specifically autism.Bromley Autistic Trust is a local organisation that provides a range of services, including three care homes and a day centre, operating within the Bromley area.The home has four bedrooms, large and small lounge, two bathrooms/WCs and kitchen. There is a large rear garden, which houses a sensory building.Burgess House is staffed by a manager and support workers, providing 24-hour care.The home has access to specialist health services via the Bassetts Centre, which also accommodates the adult learning disability team. Service users access a range of activities through a variety of outlets including the Trust’s day centre and community activities. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one weekday and lasted from 10.00am to 4.00pm. The inspector received feedback letters from the relatives of three residents currently living in the home and had discussions with two health professionals. During the course of the visit the inspector also spoke to the manager, acting deputy manager and two members of staff. The inspector was not able to communicate at any great length with residents. A brief tour of the communal areas was included in the visit along, with viewing a number of records. What the service does well: What has improved since the last inspection? What they could do better: Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 6 The home needs to ensure that the assessment procedure is comprehensive and up to date. They must also look at improving the training for permanent and sessional staff who work in the home. This needs to include core and specific training. There has been some improvement in the staffing within the home. However, the home must change its practice to ensure that there are two members of staff on duty when required and dependent on residents who may be in the home. Whilst there is a homely and comfortable feel to the home there are some areas where redecoration is required and a need to ensure unpleasant odours are eradicated. There are some good medication procedures in place. However, there are areas which need to be improved to ensure the safety of the residents. There is no quality assurance system in place at the present. This would greatly benefit the home and organisation in improving the quality of care provided. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 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 Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 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) 2, 4 & 5 Assessment procedures need to be improved upon to ensure the home is able to meet the needs of the individual and to ensure the “mix”` of clients are appropriate. EVIDENCE: There have been no new admissions to the home since the last inspection. There is currently one vacancy. Prospective service users are assessed by the Care Management team for Learning Disabilities and the organisation also undertake their own assessment. One assessment viewed contained the Care Management assessment with information provided by health professionals. This was not up to date and may, therefore not reflect the service user’s current needs. Feedback from relatives also showed concern that the home ensures full and accurate information is obtained for any prospective residents and ensures that any new resident “fits in” with the current residents. Prospective service users are invited to the home prior to admission. This is flexible and is aimed at the service user familiarising themselves with the home, staff and other service users. It also provides an opportunity for the home to assess the relationships within the home. Service users are provided with the terms and conditions of residency. This is in a pictorial and symbol format. Each service user is also provided with a copy of the placement authority contract. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 9 Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 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) 6, 7 & 9 There is a good care planning and risk assessment system in place which provides staff with the information they need to satisfactorily meet residents needs and ensuring they are able to participate in daily life with minimum risks. EVIDENCE: Communication boards, routines and personal support . Guidelines are comprehensive. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 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) 12,13,15, The home has been more proactive in encouraging residents to take part in community activities and pursuing educational and leisure interests, providing residents with a more fulfilled and active life. EVIDENCE: The records for two residents identified a weekly schedule of activities and interests. Some take part in day care activities outside of the home whilst for another it is appropriate for the day care to be brought into the home. The activities are very much geared towards the individual and their interests and therefore vary in the amount of activity. Residents were observed participating in a variety of activities during the day. This includes physical activities, activities for independent living and more educational activity. One resident was very excited to be going out shopping before the evening meal. Another resident was supported by staff, with sensitive reminders of appointments and activities for the week. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 12 Regular visits to the family home are also an important part of the resident’s life and are included in the individual schedules. Feedback from families and health professionals provide positive comments. One relative commented on the “very full life” lead by one resident. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 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 The home’s medication procedures are adequate but must be improved upon to ensure they fully promote the health needs of the individuals and ensure the risks are limited. Personal support is offered in a way in which residents dignity and privacy are respected and independence promoted. The health needs of the residents are identified and met with evidence of multi-disciplinary working taking place regularly. EVIDENCE: The two care plans viewed showed how the residents’ health needs are being. All residents have had a full health check in September 04 with a record maintained on the file. There were records of appointments made and attended with copies of reports maintained on the file. Residents are supported to attend appointments with staff from the home and in some cases family members. Health professionals provide specialist support to the home, including speech and language therapy, epilepsy specialist and psychiatric specialists from the Community Learning Disability team. This support is provided when needed for individuals. Health professionals spoken to agreed, that there has been some improvement, in this area over the last six months and that the home tries to ensure residents are provided with the support they require and act upon the treatment or actions required. There appears to be a more positive and proactive approach to accessing the health care required. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 14 The records also identified regular NHS checks such as optician, dentist and chiropody. The records also identified the best routine to support residents during these appointments. For one service user dental appointments are more problematic and therefore the best routine to support them through this is identified. For some residents records show that there has been a long time between these appointments. However, this may not be truly accurate and may be due to poor recording. Medication procedures are generally satisfactory but there are some areas which need to be improved upon. Prescribed medication and creams must be stored safely, even when kept in residents’ rooms and creams and ointments must also be recorded on medication records. When viewing the records some had been destroyed, especially those records relating to “on leave” medication. The manager must also ensure that there is no re-dispensing occurring, once again this is related to the medication for residents who were staying away from the home. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 15 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 The complaints process provides information to residents and relatives on how they may raise concerns and there is some evidence that these concerns are listened to and acted upon. Staff understanding of adult protection procedures is mixed and may result in residents not being fully protected. EVIDENCE: The home has a complaints procedure, which meets with the Care Home Regulations 2001. However, this is on display in the main entrance area of the house and not in the home, as it should be. This is in the written format and whilst suitable for visitors, is not suitable for residents. A more simplified format in pictorial and symbol form is available for people in the service users’ guide. In reality residents speak to family members of staff if they have a complaint or are unhappy. The home records all complaints. Records inspected confirmed that formal complaints are dealt with, often by a more senior manager within the organisation. However, this process could be improved upon to ensure the investigation, action taken and outcome, are recorded. The home has procedures for the use of physical intervention and staff feedback that they undertake training in non-physical intervention techniques by a trained professional. The records viewed have identified which residents require such interventions and have guidelines in place. The records should detail for each service user which techniques may be used and staff who have been trained in these techniques and are therefore able to intervene. This had been implemented prior to the report being finalised. The organisation has developed procedures for the protection of vulnerable adults. Not all staff spoken to were aware of these procedures nor has training Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 16 been provided. The home records any allegations of suspected abuse and these are investigated by the organisation. A recent allegation has been recorded and investigated by the organisation. The Commission were not made aware of this incident as required under Regulation 37 and this highlights some concerns around appropriate investigation of allegations. Staff spoken to felt that they are appropriately supported after any incidents, which may have been difficult, challenging or stressful. The PCT and BAT also include stress management training. No staff members have attended this training and considering the nature of the client groups and the demands made upon them, this training should be actively promoted to staff. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 17 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, 27, 28 & 30 The home has not addressed the outstanding issue regarding the standard of décor in the vacant bedroom, although the standard of décor and space in the home, is generally satisfactory, providing residents with a comfortable and homely place to live. EVIDENCE: The home was clean and tidy to an adequate standard during this visit. Feedback suggests that this is not always the case. There was also a strong unpleasant odour in certain areas. The cause of this was not known and must be investigated. Communal areas comprise of two lounges and a large kitchen and adequate bathrooms and WCs. There is a homely and comfortable feel throughout and decoration is to a satisfactory standard. Residents were happy to wander and make themselves comfortable in all of these areas. Furniture is also of a satisfactory quality and comfortable in appearance. The garden is laid with mainly lawn and comprises a summerhouse which house Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 18 games, and sensory equipment. These areas provide a welcome alternative for residents who wish to take part in external activities. Resident’s private accommodation has been decorated to resident’s individual taste. One individual said “ I love my room”. One room, which is currently unoccupied, has very little sunlight and the décor does little to improve this. This had been commented on in the last inspection and it is disappointing that these comments have not been taken on board to ensure any new resident benefits from a more pleasant environment. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 19 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) 32 & 35 After a period of instability in staffing there has been some progress in addressing the recent staffing problems. Whilst some staff have a good understanding of a residents needs, this is not evident with all staff. This means there is inconsistency in the care provided at times. The deployment of staff is not always sufficient to the meet the needs of the residents. EVIDENCE: Whilst staffing has improved recently and the manager and acting manager are provided with more management time, there are still vacancies with the home using “sessional” workers regularly. The manager and deputy manager stated that the roster provides for more administrative work and this is reflected in the improvement in the records viewed. The roster allows for flexible staffing to ensure the residents can participate in preferred activities. The roster identified that there are times where a member of staff may be alone in supporting two residents. This may leave residents without appropriate support and staff vulnerable. Some staff felt that, they managed this appropriately whilst others felt vulnerable. Previously, there had been a high level of incidents resulting in injuries and stressful situations. These have reduced over recent months although such situations still arise and may give rise to potentially harmful situations. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 20 Staff, health professionals and relatives agree that the skills, competencies and experiences of staff are mixed. Some staff have a good understanding of the needs of the individuals in their care and can be evidenced through the support, care and interaction. Other staff members, even after training, may not be able to implement the new knowledge and is reflected in practice. There is evidence of training being provided by BAT to permanent staff, however, this needs to be supported by ongoing supervision and monitoring of practices. Communication is viewed by staff and health professionals as one of the core areas, which requires improvement for some staff. This is being addressed through speech and language therapy input. The home provided records of training undertaken by staff…………..covering core areas. Sessional workers spoken to have not benefited from such training and there are many gaps identified. This may have resulted in the mixed feedback Observed practice during the day showed residents comfortable with staff members and interactions taking place in a warm, relaxed and friendly manner. One health professional stated that, whenever they have visited, there has always been a very relaxed approach used by staff which has benefited residents. Staff and health professional also identified other training, specific to individuals, which would improve the service provided. An example of this was epilepsy training. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 21 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) 42 & 43 The manager has a satisfactory understanding of risks to residents and adequately safeguards the health, safety and welfare of the people using the service. There is no quality assurance system in place to assess how effective the service is to ensure ongoing improvement to the quality of care provided. EVIDENCE: The home is maintained with the safety of residents and staff in mind. Health and safety records viewed showed appropriate actions and risk assessments ensuring the safety of staff, visitors and residents. Fire records viewed showed that fire instruction has not taken place in the last twelve months. Staff supported that training had not taken place and for some, there may have been no training at all leaving all individuals at risk. The home records accidents and incidents and the records viewed were satisfactory. Staff are also aware of the need to report incidents to the Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 22 Commission which may affect the well-being and safety of residents to ensure they are appropriately protected. Not all incidents have been reported. Examples of this include the reporting of allegations made against staff. The last report identified that the insurance required by the home for the protections of the home, building, public and staff safety had expired and whilst the manager was informed that the home still had appropriate cover there was no current evidence. The last inspection also noted that there is no quality assurance in place. The organisation does undertake an annual survey, which includes residents and relatives’ views. This must be incorporated into a procedure, which audits the quality of care and looks to continual improvement. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 2 x 3 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 Burgess House Score 3 Standard No 24 25 26 27 28 Score 2 x x 3 3 Version 1.20 Page 23 G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc 7 8 9 10 LIFESTYLES 3 x 3 x Score 29 30 STAFFING x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x 2 x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 3 Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 24 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. 2. Standard 2 20 Regulation 14 13 Requirement Assessments obtained by the home in relation to prospecitve residents must be up to date. Prescribed medication dispensed by the pharmacist must not be re-dispensed by the home. All medication must be kept safe within the home, including the creams and ointments kept in residents own rooms. All staff must be provided with full information on how to respond where there may be allegations of abuse made. This must include guidance on what abuse ie and the organisations procedures in reporting and investigating such allegations. The manager and provider must ensure that, where there are allegations made against staff or others, such allegations are notified to the Commission, without delay. The manager must redecorate the unoccupied bedroom located at the front of the home. This must include investigations as to how more natural light may be provided. The manager must investigate G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Timescale for action 1/06/05 1/06/05 3. 23 13 1/08/05 4. 23 & 42 13 1/06/05 5. 24 23 1/08/05 6. 30 23 1/06/05 Page 25 Burgess House 7. 32 518 8. 9. 42 39 23 10. 32 18 the cause of the offensive odours emanating litchen area. All staff, including sessional 1/08/05 workers, are provided with the appropriate training and competency is monitored. Training must include core and specific training. Staff must be updated in fire 1/07/05 procedures annually. The provider must implement a 1/09/05 quality assurance system which audits the homes procedures and takes into consideration residents views on the quality of care. The manager must ensure that 01/06/05 there is always more than one member of support staff on duty within the home when clients are in resident. 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 23 Good Practice Recommendations The manager should encourage all staff to attend the stress management trainingprovided by the organisation. Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 26 Commission for Social Care Inspection Riverhouse 1 Maidstone Road Sidcup Kent DA14 5RH 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 Burgess House G51s6938BurgessHouse.v215263.22.4.2005Stage4.doc Version 1.20 Page 27 - 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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