Inspection on 19/08/08 for Castlemount

This inspection was carried out on 19th August 2008.

CSCI found this care home to be providing an Adequate service.

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

Castlemount 15/01/08

Castlemount 16/07/07

Castlemount 28/09/06

Castlemount 09/05/06

Castlemount 28/10/05

Castlemount 25/04/05

Castlemount 18/11/04

Castlemount 22/07/04

Castlemount 17/05/04

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Abbey The

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Hawkhills

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Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Castlemount 54 Manygates Lane Sandal West Yorks WF2 7DG Lead Inspector Gillian Walsh Key Unannounced Inspection 10:00 19th & 21st August 2008 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 Castlemount DS0000006172.V370416.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. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Castlemount Address 54 Manygates Lane Sandal West Yorks WF2 7DG 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) 01924 251127 CastleMountRes@aol.com Mr Abbass Bagheri Satari Mrs Julie Ann Satari Manager post vacant Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 15 The maximum number of service users who can be accommodated is: 15 15th January 2008 2. Date of last inspection Brief Description of the Service: Castle Mount Care Home is a four-storey grade 2 listed building situated in Sandal on the outskirts of Wakefield. A short distance walk from the home is a bus service running to Wakefield and Barnsley. The home provides care and accommodation for up to 15 older people who may have past or present mental health problems. The building is set back in its own grounds, some car parking space is available at the front of the home. Wheelchair access to the home is not available. The home has nine single and three double bedrooms (one of which is being used as a single), ensuite facilities are not provided however communal toilets and bathing facilities are available on all floors, which are accessible, by chair lift. A large entrance hall leads to the two communal lounges and dining area. The provider makes information about the service available to enquirers via a leaflet about the home and the home’s service users guide. Details of the Commission for Social Care Inspection are also in the Service User Guide. The acting manager said in August 2008 that current fees are from £388 to £400; hairdressing chiropody and personal newspapers are charged in addition to the fees. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit made to Castlemount over two days. On the first day one inspector from the Commission for Social Care Inspection spent time speaking with people who live at the home, staff and the acting manager, looking at documentation and looking around the home. The visit started at approximately 10am and finished at approximately 5pm. On the second day a pharmacist inspector conducted an inspection of the systems for managing medication in the home. Prior to the inspection the Commission had sent an Annual Quality Assurance Assessment form to the home, which the manager had completed and returned. This document gives information to the Commission about what the home is doing and what they plan to do to improve the quality of life for people living at the home. Surveys, for people to give us their views about the service, were left at the home for people who live there, their relatives and staff working at the home to complete and return to the Commission. Three surveys were completed and returned by staff from the home and two were completed and returned by people who live at the home. All of these surveys were very positive and comments are included in the body of the report. One of the people who lives at the home summed up by saying “I would like to tell you that carers and the managers are wonderful and I get the full care at Castle Mount” What the service does well: People living at the home are very happy with the care and attention they receive. One person said in a survey “I would like to tell you that carers and the managers are wonderful and I get the full care at Castle Mount. I have visited many homes but there is no home better than Castle Mount” People were also very happy with the activities and social care. Everybody spoken with said how much they enjoyed the meals. Staff have a caring and respectful attitude. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is Adequate. People will not move into the home without having their needs assessed and being given confirmation that the home can meet these needs. Castle Mount does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager said that there have not been any new admissions to the home since the last key inspection. In anticipation of referrals being received, the acting manager has developed a new assessment form, which she said would be used during all future pre admission assessments. The form was comprehensive, covering all aspects of a persons needs within their daily lives. This should give staff an insight into Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 9 people’s physical, psychological and social needs before they are offered a place at the home. Castle Mount does not provide intermediate care. Castlemount DS0000006172.V370416.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, 8, 9 and 10. Quality in this outcome area is Good. People’s health and social care needs are laid out in care plans and are met in a way that respects their privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the visit to the home, four care plan files were looked at in detail. All of the care plans seen had been completely revised since the last inspection. Each file contained a care plan, which in almost all of the plans seen gave the reader a clear understanding of the individuals needs, and the support they need from staff to enable them to meet these needs. The care plans included people’s preferences in how they liked their care to be delivered and gave details of their likes and dislikes in relation to such things as food and drinks and toiletries. Evidence that care plans are read and actioned by staff was available in daily records, an example of this being that in one persons care Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 11 plan it said how much they enjoy watching sport, daily records then indicated that this person had spent their time watching their preferred sports. Care plan files included a number of assessments such as moving and handling and nutritional assessments. Discussion took place with the acting manager about one persons moving and handling assessment and related care plan both of which said that the person needed to use the hoist for transfers. However the inspector observed staff to attempt, unsuccessfully, to transfer the person from chair to wheelchair using a handling belt. Also the hoist and sling type and size were not included in either the assessment or the care plan. The acting manager said that she would make a referral to the physiotherapist to make sure that a proper assessment was done. All of the files seen included a care plan agreement form signed by either the individual concerned or, where appropriate, their next of kin. Evidence was available in all of the files seen that referrals are made to healthcare professionals as and when the need arises. One person who returned a survey to the Commission said, “I always receive the medical support I need. If there is anything wrong with me they ring a GP for me” Visits from GP’s, mental health nurses, physiotherapists, district nurses and opticians were all recorded in the files seen. A CSCI pharmacist inspector once again visited the home. The visit looked at arrangements within the home that support the safe handling of medicines and whether the requirements and recommendations made at the last pharmacy visit had been met. Significant improvements have been made to the management of people’s medication in the home. There is now a good system in place for the accurate administration and recording of medication. Medicines are now stored safely and securely. This means that people are receiving their medication as intended, which helps to make sure their medical condition is being treated correctly. The medication policy has been reviewed and updated. There is now detailed information for staff on current legislation and guidance to make sure that safe practices are followed. This helps to make sure people get their medications as prescribed. The current Medication Administration Record (MAR) charts were looked at. There is now a list of staff authorised to administer medicines and examples of their signatures. This means it is possible to know who was involved in medication administration if a query or problem occurred. The code ‘F’ when used to record no administration is now defined. It is important that a clear reason is given so there is accurate information on how Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 12 a person is taking their medication. The prescriber, who may wish to review the medication, may also use this information. The quantity of medication from one monthly cycle to another is now recorded on the new MAR. This helps to know how much medication is kept for each person within the home and when checking if medication is being administered correctly. An audit of current stock and records showed that accurate administration now takes place so that medication is being given as prescribed. Medication requiring cold storage is now kept in a clinical fridge that is locked and the temperatures are taken. Such medication is now at a reduced risk of being tampered with and is being stored correctly so will be safe to administer. A system is now in place to check the expiry dates of all medicines to make sure they are safe to use. The controlled drugs cupboard and register were seen and are suitable for use. The supply of temazepam is now in a bottle, which allows it to be stored properly. All of the people who live at the home who were spoken with during the visit were very complimentary of, and spoke fondly of, the staff at the home. One person said in a survey “Everyone is marvellous to me, I couldn’t do without the carers”. Observations made during the visit were that staff had an easy, comfortable and mutually respectful relationship with the people who live at the home. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is Good. People are supported to make choices to suit their lifestyles and preferences. Meals are of good quality. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the files seen contained care plans for the individual’s social and recreational needs. Also included in each file are individual biographies, which include meaningful dates such as birthdays and anniversary’s and a reminiscence sheet which is given to people and their families to complete. The sheet asks questions about the person’s life, family, interests and special events before moving into the home. The sheet concludes with a message from staff, which reads “Thank you for sharing your memories with us”. Very positively one family had responded by saying ‘Thank you for asking, it’s good to know that it is recognised that the old people at the home are real people with families and pasts’ Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 14 People who live at the home said how much they enjoy the entertainers who come to the home and also the activities staff do with them every day. One person had recently had a birthday and staff had laid on a party, which was attended by relatives and friends of many of the people who live at the home, past and present staff and some of their families. The person said that the day had been a huge success and showed the inspector photographs from the party. People were looking forward to a trip out which had been organised for the following weekend. People said how much they enjoy visits from their friends and families and the acting manager confirmed that visitors are always made welcome. Some relatives who were spoken with during the visit said that they felt welcome at the home and have found recent staff changes very positive. Care plans; observations during the inspection visit and talking to people who live at the home confirmed that people are encouraged and enabled to exercise choice within their lives. An example of this was when care staff were asking people what they would like for their tea. Rather than being offered set choices people were asked, “what do you fancy for your tea?” When people asked what there was, a wide range of choices was offered. People said that they very much enjoyed their meals and could take them where they chose if they didn’t want to go to the dining room; one person said in a survey “they do a diet to suit my needs”. The lunchtime meal on the day of the visit looked appetising and nutritional and people were offered choices. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is Good. People living at the home feel safe and confident that they can raise concerns if they need to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who responded to surveys said that they would be happy to speak with any of the staff or the acting manager if they had any concerns or complaints. Some visitors spoken with said that, since there has been a change in staff, they feel they can discuss any concerns. Since the last key inspection there have not been any complaints made to the home or to the Commission about the home. The acting manager said that all but two of the staff team have received training in recognising abuse and safeguarding people. After training the acting manager said that she goes through the content of the training with staff to check their understanding. Staff spoken with were aware of how to make a safeguarding referral under multi agency procedures. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is Poor. People could be put at risk of cross infection by poor maintenance standards within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although the home was clean and tidy it was disappointing to see that that had been some lack of attention and expenditure with regard to maintenance of the home. Redecoration of an area damaged by a water leak, identified at the last inspection, had not yet been done although the acting manager said it was due to be done the weekend following the inspection visit. There were also problems with heating and hot water on the top floor of the home where the boiler had not been working for four months. This meant that Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 17 the person who occupies a room on this floor had not had any heating or hot water in their room during this time. Mechanical ventilation units in two bathrooms and the laundry room, situated along with bedrooms and the office in the cellar, were not working thus preventing the required air exchanges from taking place and therefore increasing infection risks. A handwritten notice on the unit in the laundry room showed that it had not been working for over four months. The light, along with the ventilation unit, in the bathroom situated in the cellar was not working and commode pans were found soaking in the bath. A tumble dryer was being used in the room and signs of damp were evident on the walls. The acting manager was aware of all of the above and had informed the provider who is also the owner of the home, of the maintenance problems who had not yet sanctioned the expenditure to replace the boiler or air ventilation units. Although the home does not have access for people who are unable to mobilise, a new stair lift has been fitted to ease access to and from the home for people with reduced mobility. Two bedroom windows on the first floor of the home were found to be unrestricted. This meant that they opened very wide which a person could have fallen through. The acting manager had window restrictors fitted before the inspection had concluded. At the time of the visit the inspector had not been sent any regulation 26 reports from the provider, as required in the last inspection report. Reports from April, May, June, July and August were sent to the inspector by email after the inspection visit had concluded. Whilst the provider says in the August report that the boiler is to be replaced in September, there is no mention of the broken air ventilation units or of the lack of sluice facilities or bedpan washer to clean commode pans. Lack of operational air ventilation units and equipment to clean bedpans could result in problems of cross infection within the home. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 18 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, 28, 29 and 30. Quality in this outcome area is Good. Appropriately recruited and trained staff support people who live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager and senior care assistant said that they felt that staffing levels were appropriate to the needs and numbers of people living at the home. People who completed surveys said that staff always came quickly when they called or used the buzzer. In information supplied to the Commission prior to the inspection visit, the acting manager said that the majority of care staff have achieved NVQ (National Vocational Qualification) level 2 in care and that several staff are working towards higher levels. Staff spoken with, and those who returned surveys, confirmed that they receive regular training and feel competent and confident in their roles. A selection of staff files looked at contained evidence that proper recruitment practices are followed to ensure the safety of people living at the home Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 19 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 and 38. Quality in this outcome area is Adequate Lapses in the management and administration of the home could have a detrimental affect on people’s health, safety and welfare if not attended to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been an acting manager in post at the home for several months but she has not applied to the Commission to be registered as the manager. Since this person took on the management of the home there have been several changes of staff and improvements in care practices. Some visiting relatives commented on these improvements. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 20 The owner and registered person for the home is not in day to day contact with the home but visits on a monthly basis. At the last inspection, the registered person was required under Regulation 26 of the Care Standards Act, to send the Commission copies of her monthly quality assessment reports of the home so that the Commission were aware of, and could assess the affects on people living at the home, of any changes, improvements or problems within the home. The registered person did not send these reports until asked about them by the acting manager on the day of the inspection visit. However, people who live at the home felt that recent changes had been for the better and felt that the registered person and the staff at the home had their best interests at heart. Small amounts of people’s own money are kept on their behalf and at their request in the home’s safe. A selection of balances and related documentation were checked and found to be correct. Although there is no evidence to show that issues relating to lack of hot water, heating and ventilation in some areas, lack of restrictors on some windows and lack of adequate equipment for the cleaning of commode pans and the poor practice as a result of this, have had a detrimental affect on people’s health and well being, there is a risk and therefore must be addressed without further delay. Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 21 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 2 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 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 2 X 2 X 3 X X 2 Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 22 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 OP19 OP38 Regulation 23(2)(p) Requirement All areas of the home, accessed by people who live there, must be adequately heated, ventilated and have supplies of hot water, to ensure peoples comfort and well being. Revised requirement from original compliance date of 18/01/01 2. OP33 26 Record must be made of monthly 30/09/08 quality monitoring visits to the home by the registered provider. This is so they can measure the quality of service people living in the home receive. The registered person must forward of a copy of these reports to the Commission for Social Care Inspection each month. Repeated requirement from original compliance date of 30/04/08 Timescale for action 30/09/08 Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 23 3, OP38 13(3) Appropriate equipment to clean commode and bedpans must be provided to avoid the spread of infection. Bedpans must not be cleaned or soaked in baths. 31/10/08 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 OP33 Good Practice Recommendations Quality monitoring should be developed and continued to make sure that the views of all people concerned with the home, and in particular, those who live at the home, are taken into account. An application for the position of registered manager should be made to the Commission for social care inspection 2. OP31 Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Castlemount DS0000006172.V370416.R01.S.doc Version 5.2 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. 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