Inspection on 03/09/07 for Cedar Lodge

This inspection was carried out on 3rd September 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.

Other inspections for this house

Cedar Lodge 11/10/06

Cedar Lodge 11/01/06

Cedar Lodge 27/09/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Cedar Lodge 169 Westbury Road Southend on Sea Essex SS2 4DL Lead Inspector Ann Davey Unannounced Inspection 3rd September 2007 09:00 Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 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 Cedar Lodge DS0000062765.V345801.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 Adults 18-65. 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. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cedar Lodge Address 169 Westbury Road Southend on Sea Essex SS2 4DL 01702 301652 01702 217625 bronwynoldham@hotmail.co.uk 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) Westelm Homes Ltd Manager post vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2006 Brief Description of the Service: Cedar Lodge is a care home providing personal care and accommodation for eight residents who have a learning disability. The home is a detached eight bed roomed chalet which is situated in a quiet residential area in the Southchurch area of Southend. The home is located close to local bus routes and shops. All residents have their own rooms. Communal areas include a spacious lounge, a dining room and large kitchen. There is an attractive patio area to the rear of the home and good car parking facilities to the front. The home provides day care facilities for residents accommodated. The current scale of charge ranges between £675.95 - £911.85 per week. The actual fee depends on the source of funding, the level of personal care required and the level of day care support/provision provided by the home. The home is currently revising its Statement of Purpose and Service User’s Guide. Copies are available from the home upon request. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced site visit that started at 9am and finished at 2pm. The last key inspection took place on 11th October 2006. The home had completed and retuned their Annual Quality Assurance Assessment to the Commission prior to the inspection. The manager, staff and residents were spoken with during the course of the inspection. The Commission sent surveys to the home for residents (or their representatives) and staff to complete and return. Four surveys from residents and three surveys from staff were completed and returned. Comments from the surveys have been reflected within the report. Residents living in the home have varying levels of communication skills and abilities. This influenced the manner in which the inspector was able to discuss various aspects of living in the home with residents. The inspector was only able to spent about an hour with residents as they were going out for the day either to a day care support provision or shopping with staff. The limited time spent with residents was very productive and the outcome of these conversations has been reflected within the report. The day was pleasant and the home co-operative and helpful. The home has been without a registered manager for 12 months and is currently managed on a day-to-day basis by a director of Westelm Homes Ltd (registered provider). Two residents kindly agreed to show the inspector around the home. Care practices were observed and a random selection of records viewed. A notice advising any visitors to the home that an inspection is taking place is normally displayed. On this occasion following discussion with the manager, it was felt that displaying the notice would not be beneficial. All matters relating to the outcome of this inspection were discussed with the manager. The manager took notes so that development work could be started. Full opportunity was given for discussion and/or clarification both during and at the end of the inspection. What the service does well: Cedar Lodge has a number of strengths. The home is effectively managed on a day-to-day basis. This means that communication and documentation systems are established and work well for the home. The home is ‘resident led’ and ‘resident focused’. The manager and staff used terms during the inspection such as we are here to ‘support’, ‘facilitate’, ‘enable’ and ‘empower’ residents. From observation of practice, discussion with Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 6 staff and residents and from reading a sample of records, the inspector would endorse these views. The home facilitates and supports residents in experiencing and enjoying an excellent gender and age appropriate social, recreational, educational and occupational lifestyle. Residents are well integrated into the local community. Residents’ benefit from a stable group of staff. There has been no change in the current staffing establishment for 12 months. The home environment is warm, comfortable and homely. 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. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive a comprehensive pre-admission assessment. EVIDENCE: No new residents have been admitted to the home since the last inspection. The home has a clear admission policy and procedure in place that would be used if a new admission were considered. Information within surveys confirmed that residents had been consulted about their move into the home and had received sufficient information about Cedar Lodge. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a plan of care drawn up by the home that reflects their wishes and details their assessed needs. EVIDENCE: Three plans of care (known as Person Centred Plans in the home) were assessed. Documentation is ‘resident focused’ and written in the ‘first person’ i.e. ‘I (the resident) like to do…’ or ‘I do not like…’. Text within documentation is in ‘user friendly’ format. Residents are fully involved in their care plans. The system would be further improved if the respective resident was to indicate on the documentation that they are in agreement with what has been written, or for the home to state that the plan of care has been explained to the resident and has been agreed. The home understood the importance of developing the ‘end of life’ wishes and preferences section on documentation following consultation with families and taking into consideration the feelings of residents. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 10 The manager acknowledged that the section on documentation that refers to the residents’ personal care needs should be developed as information and guidance is brief. The care plan documentation system was in good order and current. ‘In house’ care plan reviews take place. The home is disappointed that local authority reviews are not taking place on a regular basis. The local authority has told the home that reviews have not been undertaken due to staffing resources. The home maintains an effective daily record that details the activity of each resident. Staff spoken with had a good understanding of individual residents care needs. Comments from staff surveys indicated that staff have access to information about residents that enables them to provide appropriate care. Through observation of care practices in the morning, staff demonstrated a good understanding of when and how to use appropriate behavioural management techniques. Communication between residents and staff was friendly, supportive and natural. Information within residents’ surveys indicated that are satisfied with their care and confirmed that they are involved in decision making processes within the home. Three residents spoken with indicated that they were happy in the home. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents can expect to be fully supported in participating and experiencing a variety of social, leisure, educational and occupational activities and be provided with a balanced diet. EVIDENCE: The home excels in this area of care. Care plans contained detailed information about the wishes and preferences of residents. The home provides day care support facilities/opportunities and employs designated staff to undertake these duties. Each resident has a structured Monday - Friday programme which includes external day centres, community skill training, training centres, paid employment, college activity, art classes, swimming classes and ceramic skills. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 12 On a recreational and social level, there is a wide and varied evening and weekend programme for residents to choose from i.e. music school, cookery club, sports club and evening social clubs. Residents enjoy and participate in local community events and four attend a local church on a regular basis. Activities available for residents are age and gender appropriate. The home has two mini buses to transport residents wherever they need to go. One resident told the inspector that ‘I go out a lot’ and ‘I like what I do’. Another resident said ‘ they ask me about what I’d like to do, they always ask me, they do’. All residents have contact with their respective families to varying degrees. Residents bring their friends back to the home. The home was able to demonstrate how it supports residents in maintaining friendships and personal relationships outside of the home. The home demonstrated how it acknowledges and meets diversity and cultural needs. Feedback from residents’ surveys was very positive about activities. Residents spoken with were excited about their respective planned and varied activities for the day. A small group of residents were going to a local shopping centre. The dialogue between staff and residents in planning this trip was very ‘resident’ focused. Residents were being asked about what they would like to see and do whilst there. Residents were being supported in helping to focus of other aspects of the trip such as ‘what clothes are we going to look for’ and ‘what sort of shop sells them’ and ‘where would you like to go afterwards.’ Records indicate that residents are provided with a good balanced diet. The fridge and freezer was well stocked and there was plenty of fresh fruit available. Apart from the ‘traditional’ meals provided by the home, residents also enjoy ‘eating out’, ‘take a way’s’ and BBQ’s. Resident’s weights are regularly monitored as part of the care process. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive good health and personal care support. EVIDENCE: Care plans demonstrate that resident’s health, emotional and personal needs are assessed and recorded. Assessed needs are written in the ‘first person’ i.e. ‘I like to do this’ or ‘this makes me happy’, demonstrating that resident’s views, opinions and wishes are fully considered. Residents were dressed in keeping with their age and gender. Two residents confirmed that they choose what they wanted to wear that day. Residents are registered with one of two local GP practices. There is a choice of male or female doctors. The home said that it has a good working relationship with all community health care professionals. Some residents have diagnosed medical conditions and associated medical/health care needs are clearly recorded by the home. Medication is stored in a secure place. The storage of medication was orderly and there was no evidence of overstocking. There were no anomalies within Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 14 the medication administration recording system. PRN (as/when required) medication administration protocols were in place. The home has a medication administration policy. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have their complaints taken seriously and be protected by the home’s ‘safeguarding adults from harm’ procedures. EVIDENCE: The home is currently updating the residents’ complaints procedure to put it in a more ‘user friendly’ format. Three residents spoken with indicated they would raise anything that mad them unhappy with a member of staff and understood that they had a right to do this. Information within all the completed surveys indicated that residents knew what to do if they were upset about something. All residents are well integrated in to the community and have a number of independent links i.e. day centres, employment, college and church. The home has a designated complaints record book. No complaints have been recorded since the last inspection. The home works on the basis that good communication prevents misunderstandings that could lead to a complaint or a dissatisfaction being raised. The manager and a senior member of staff were aware of the ‘safeguarding adults from harm’ reporting procedures. The home’s ‘safeguarding adults from harm’ policy and procedure requires updating to bring it in line with current local authority guidance. The home was to contact the local authority for further advice. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a clean, comfortable and safe environment. EVIDENCE: A partial tour of the home was made. Two residents accompanied the inspector. The environment was warm, bright and comfortable. With their consent, both residents showed the inspector their respective bedrooms. Both were decorated and furnished to reflect personal taste, gender and age. Communal areas were clean, homely and comfortable. An informative and well stocked ‘residents notice board’, a ‘pictorial’ staff rota and the current weekly activity schedule were on the wall in the dining area. One resident made reference to the rota to show the inspector who was on duty. Utility area such as the kitchen and laundry were clean, tidy and orderly. Cupboards containing cleaning substances were locked. The home has recently Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 17 created a good-sized patio area with comfortable tables and chairs. Planted shrubs and flowerbeds make this a very attractive area for residents. A regular programme of maintenance and decoration ensures that the environment is maintained to a good standard for residents. Feedback from residents’ surveys was positive about the home. During the inspection, one resident said ‘I like my room’ and another said ‘I live here, it’s nice’. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 & 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by a team of trained staff in numbers that are adequate to meet assessed needs. EVIDENCE: The rota demonstrates that there is a minimum of two care staff of duty during the day. In addition, two other designated day care staff are on duty during the day Monday – Friday to provided day care support services. The home employs a domestic/ cleaner for 20 hours a week. At night there is a ‘sleep in’ member of staff. When residents are all out during the day i.e. day centres, college, there is always one member of staff present in the home. The home has had no staff vacancies since the last year and a number of staff have worked in the home for some time. The home does not use agency staff. Staff training records demonstrated that the home provides good training opportunities. Records were available to demonstrate that regular staff supervision sessions take place and staff meetings are held. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 19 The home was able to demonstrate that it has effective staff communication systems in place i.e. written and verbal ‘daily handover’s’ and a staff communication book. The manager said that staff sickness is minimal. Staff spoken with had a clear understanding of their respective roles and responsibilities. Staff demonstrated competence in their work by explaining what they did and why it was important. Two staff have completed their NVQ level 3 training, 5 staff have completed their NVQ level 2 training and a further three are undertaking their NVQ level 2 training. One member of staff is starting the NVQ level 4 course. Feedback from staff surveys was very positive. All indicated that they enjoyed working in the home and felt supported by the manager. Feedback confirmed that staff are provided with training and supervision. All indicated that their motive for working in the home was to provide quality care for residents. The manager said that members of the staff team were valued and their contribution to the home was appreciated. The manager acknowledged that the home had a stable group of experienced and competent staff. Staff told the inspector that ‘it’s nice working here’, ‘I get good support and everybody is friendly’ and ‘we work together well as a team’. Residents told the inspector ‘staff are kind’ and ‘they’re all nice to me’. Interaction between staff and residents was warm, natural and friendly. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 20 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,41,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home that is managed in a competent manner. EVIDENCE: The home does not have a registered manager but is managed on a day-today basis in an effective and competent manner by a director of the company that owns the home. The home was able to demonstrate how it is actively considering the vacant registered manager’s position. Staff through written and verbal feedback expressed confidence in the management structure. Staff were unanimous in that they felt supported in their work. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 21 Communication systems are effective and ‘user friendly’ i.e. reports that staff are required to read and/or complete are managed in a way that information is current and informative. Staff are expected to take ‘ownership’ of their work and this helps to promote good report writing skills. From observation during the course of the day, the working relationship between staff and management is effective, supportive and friendly. Staff and management work well together as a team. It was positive to see how the views and opinions of residents are sought in a variety of ways i.e. residents meetings, 1:1 sessions with staff and external independent advocacy meetings. These established processes underpin the manner in which the home is managed. The home has a ‘Policy and Procedure’ folder. Documents were in alphabetical order and current. Many documents are in ‘easy to read’ style. Environmental and safe working risk assessments were current and in place. The home has an accident policy and an accident record book was in place. Records were available to demonstrate that fire drills are carried out on a regular basis. Other records i.e. emergency lighting and water temperature checks were in place. A selection of service and maintenance certificates were seen and found in good order. The home is currently implementing a quality assurance system and a concluding report will be sent to the Commission by the end of the year. Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 4 33 4 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 X 3 3 4 3 4 Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 23 No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cedar Lodge DS0000062765.V345801.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Cedar Lodge DS0000062765.V345801.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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