Inspection on 31/01/06 for Chasefield House

This inspection was carried out on 31st January 2006.

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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chasefield House 26/06/07

Chasefield House 19/02/07

Chasefield House 09/04/05

Chasefield House 04/11/04

Chasefield House 26/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Chasefield House 888 Fishponds Road Fishponds Bristol BS16 3XB Lead Inspector Andrew Pollard Announced Inspection 31st January 2006 09:45 Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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 Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chasefield House Address 888 Fishponds Road Fishponds Bristol BS16 3XB 0117 9653750 0117 9709301 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mr Michael Christopher Rogers Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To comply with the Staffing Notice dated 30/01/1995, amended 22/8/05 Manager must be a RN on parts 5 or 14 of the NMC register The Home may accommodate up to 15 persons aged 18 and over, who have learning difficulties and require nursing or personal care. 9th April 2005 Date of last inspection Brief Description of the Service: Chasefield is registered as a Care Home with nursing for 15 adults with learning difficulties.The house is situated in an urban location and can easily be accessed by car or bus.The nearby Fishponds Road high street is a busy shopping centre and has various social and community facilities.The house is a converted older property providing double and single rooms in three areas. There are two lounges, a dining room and a well-equipped workshop.The house has an extensive rear garden and vegetable garden, which residents can help maintain. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering has been used in the production of this report; observation, pre-inspection questionnaire, discussion with residents and staff, relative comment cards, tour of the home and sampling policies, records, care plans. The building is large and old and would not be suitable as it is for people with physical disability and the frail elderly. This is of concern due to the increasing age profile of the current resident group. Plans are in place to improve and update the environment and creating new dwellings and making better use of the buildings in the grounds. Chasefield is a well run home offering a good standard of care and quality of life. The inspector’s overall impression was that the residents were happy, settled and secure and the staff have a good rapport with the residents. During the visit the inspector with a number of residents, who made positive comments about the home. Staff were observed talking with residents in a sensitive and friendly manner. A small number of staff have known the residents for many years and have an in depth knowledge and understanding of their needs. What the service does well: The manager and staff demonstrate a commitment to working toward a person- centred care regime in the home and empowerment of residents. Residents are treated as individuals, with respect and dignity. People are given the opportunity to attend a varied range of social, therapeutic and leisure activities. There is a commitment to enhance the quality of life for residents. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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 Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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 the following standard(s): 1,2,4 Prospective residents are given information in written or verbal form about the home. The assessment process is rigorous and detailed. Introductory visits are arranged for prospective residents. EVIDENCE: The statement of purpose and accompanying service user guide are unchanged but will have the updated and a business plan added in due course. The documents had been written in a straightforward way and were easy to understand. All residents are admitted via Social Services through the placement team and the community nursing learning disability team. One new resident has been admitted since the last inspection The manager assessed their needs and the home’s ability to meet the needs, gathered information from a consultant, social worker. A number of day- time visits have taken place and shared a number of meals prior to admission. The person centred assessment records includes information about important events in the person’s life, a detailed assessment of care needs, general likes and dislikes, preferred social activities, and choice of diet. All residents have a contract agreements and those able to have signed them. All the residents’ needs are to be reassessed by Social services in the coming months. There are a number of older people who may not be best placed at Chasefield due to the nature of the building and their increasing frailty. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 9 Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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 the following standard(s): 6,7,9 Residents are involved with the assessment and care planning/goal setting process The homes philosophy promotes resident’s individual development, selfdirection and empowerment. EVIDENCE: The named nurse and key worker system has been reviewed due to the recent staff changes in the home. The IPP process has not been kept fully up to date but reviews are now being booked and the process will be back on track shortly. All residents have care plans, which aim to address their physical, mental, and social needs using a person centred approach. A pictogram document is available to support this approach. All goals and care plans are reviewed six monthly and in general this has been done. Essential lifestyle planning has yet to be fully introduced due to a recent large turnover of staff. There was evidence that residents had been consulted where practical in planning their care. Progress has been made to back file old information and keep the files as Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 11 current working documents. All residents have individual risk assessments and competences in their files. A number of these documents need review. There was detailed information about any potential risks and risk behaviours that may be exhibited. Any restrictions of liberty or choice are supported by a risk assessment and care plan. Staff support residents with appropriate risk taking within the community. A copy of the minutes for recent residents meetings showed that resident’s were consulted about a range of in house matters and their ideas for social and recreational activities. The manager hopes to develop these meeting to make them the key venue for decision making in the home. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12,13,14,17 Residents have opportunities to take part in a range of community and leisure activities. The recreational and occupational arrangements in the home are well organised and varied. The menus are varied and offer a balanced diet. EVIDENCE: Residents attend the St George & Kingswood resource and activity centres, the Lawrence link centre and Emerson’s Green art project. Other people have activities planned in and out of house by day care staff. Four day care workers are attached to the home working a total of 37.5 hours a week. There are in addition extra hours for walks, working in the gardens and workshop. A part time cook is to be recruited and it is intended that he will work some hours with residents in the training kitchen. The introduction of reflexology/massage sessions has been a success. Depending on their wishes individual residents are encouraged to engage with the local community. They are encouraged and assisted to attend local community services and facilities. Residents go out to the local shops accompanied by staff. At present no one is Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 13 able to go out independently. Regular outings are arranged and annual holidays to places such as Torquay or Pontins some residents are more suited to day trips and a number of people go out or stay with relatives. Each resident has a timetable of activities showing a range of therapeutic, social and recreational activities. Some residents have the opportunity the opportunities to attend activities such as library, cinema, pubs, bowling and swimming. Certificates of achievement were displayed in bedrooms showing that residents had attended classes such as pottery, and arts classes. The home has an account with the Hippodrome and residents have the chance to see many of the productions staged there. One resident attends a local church from time to time. A revised photo menu pack is being produced with the chef to improve the resident’s involvement with menu planning and identifying their likes and dislikes more accurately. This will be used in conjunction with twice weekly shopping trips so residents are involved with the purchasing of food. The main meal of the day is being changed from afternoon to evening. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 18,19,20 The staff provides appropriate personal and nursing care in a sensitive manner to maintains residents health and well being. Proper arrangements are in place for residents to access primary and secondary healthcare services. The staff properly manage and administer medication. EVIDENCE: Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 15 A Registered nurse heads up each team of support workers. Care plans are written in a way to maximise people’s independence. All the residents require prompting or support to manage their personal care. It was observed that residents were well dressed and groomed and wore clothes that were individual in taste. The consultant Dr Carpenter has an SHO who visits about every three to six months and carries out reviews and gives advice. All residents are registered with a local GP with whom the home has a good working relationship. The doctor carries out an annual physical health check for each resident. There have been recent referrals to the PCT Physiotherapy and OT services. Whenever possible the community services for dental and optical care are utilised however arrangements can be made for domiciliary visits if need be. The chiropodist visits all residents at the home. Medication is ordered and delivered every 28 days, which enables good stock control. The Lloyds Pharmacy MDS (blister system) and MAR are in use. The drug storage and trolley are to be relocated into the office in the near future. The storage, receipt, administration, and disposal records were up to date and in good order. The manager states that the pharmacy is registered to dispose of unwanted medication. None of the residents are able to manage their own medication. Each resident is to have an updated drug profile with the MAR. The suction machine is in working order and properly equipped and is easily assessable. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 22,23 There are robust and comprehensive policies in place to manage complaints or allegations of abuse. There are good arrangements in place for staff training and awareness of POVA matters. EVIDENCE: The complaint procedure is prominently displayed in the hallway. The contact information for the area office of CSCI is included. There is a complaints procedure using symbols that may be accessible to some residents. In general many residents would require staff or others to advocate on their behalf. The complaints record that showed no complaints have been received. One comment cards from a relative had no complaints. The Trust has a whistle blowing procedure in place called “do the right thing” which is kept in the polices and procedures file. There is a copy of the Bristol and South Gloucester Local Authority “No Secrets” guidance in the home. All staff have received “alerter” level of training related to the Trusts policies. The personnel department of the Trust carry out criminal record and POVA checks on employees. There have been no reported POVA incidents. There is little aggression displayed by residents although there are occasional incidents and one resident is presenting some challenges at present. All staff receives two days of training in breakaway techniques. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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 the following standard(s): 24,25,27,28,30 The home is generally well maintained clean, safe and comfortable. Bedrooms and communal rooms suit the needs and tastes of the residents. EVIDENCE: There are detailed plans drawn up for the redevelopment of Chasefield, which will provide purpose built homes at the rear, bed-sit type accommodation on the first floor, relocated kitchens, dining rooms and workshop and many bedrooms having en-suites built. The work is hoped to commence before the end of the year. There is now only shared room following the reduced registration. Bedrooms were clean and tidy and extensively personalised with artwork, photographs and personal items. Several of the residents showed me their rooms and seemed very pleased with them. All bedrooms were decorated in individual styles and where able to residents had been involved in the choices of colours and fabrics for redecoration of their rooms. There was a good quality pine wooden wardrobe, and a chest of drawers in each room. Not all bedroom doors have a lockable facility, however residents have been asked if they would like a lock and key, which can be provided if requested. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 18 There are several communal areas, including two main lounge areas, a dining room in the basement, an activity room and a small therapy area. The general state of décor is satisfactory but tired, however due to the impending building works it is pertinent to delay extensive redecoration at this stage. There are some adaptations such as handrails and a bath hoist in the home, however at present the home is not suitable for severe mobility problems. Two lifts are likely to be installed as part of the overall building work. The home was clean and hygienic. There were no malodours. Laundry facilities are suitable although some work is needed to prevent overspill from discharging washing machines. Some residents are able to take part in doing their own laundry. There is a large workshop located in the bottom of the garden. There is a large garden, which is divided into areas that are used for recreation and growing, plants and fruit and vegetables. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 The home is adequately staffed with appropriately trained and experienced staff. The recruitment procedures and records are in good order. Proper training arrangements are in place for care staff. Clinical updating for RN’s needs to be improved. EVIDENCE: Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 20 The Home is registered to provide nursing care and there is at least one registered nurse on duty over twenty-four hours. Three staff work the night duty, one waking RN and support worker and one on a ‘sleeping in shift’. The nurse staffing levels are in accord with the notice issued by Avon Health Authority. The manager works entirely supernumerary hours. An amendment to the staffing notice was discussed to remove the sleep in provision and have one RN and a support worker on a waking night shift and reflect the new shift pattern. An application to amend the staffing notice is likely to be submitted. A number of the staff are long standing and have experience working with this resident group. However, many staff have recently left around the same time, which did require a high usage of bank and agency staff. The situation will begin to improve as new staff have now been recruited and staff are using up annual leave before the end of March. There remains one full time RN vacancy. There is adequate provision of ancillary staff, Housekeeping, Catering, and Gardening staff. However, the housekeeping arrangements are to be changed to seven days per week cover and an advert has been placed for a permanent weekend cook. The Trust has put copies of recruitment documentation into the home and those files examined were in good order. The HR department has carried out NMC and CRB/POVA checks. All new recruits are linked to a mentor and complete a standard Trust induction process and in addition an in house orientation linked to LADAF standards. The NVQ programme has faltered due to staff changes although the manager considers this will resolve shortly. The RN training records will be reviewed at the next inspection, the manager felt there had been a lack of clinical updating recently. Ms Oakley has taken responsibility for the co-ordinating compulsory training including Health and Safety (H&S), load handling, 1st aid, and food hygiene and fire safety. The training records did show a consistent pattern of staff completing this training. General learning priorities this year includes; dementia, continence, and pressure sore prevention. The Trust does facilitate or provide a range of training opportunities; a new prospectus will be issued in April. A staff away day is arranged for March to be facilitated by the manager and a clinical Psychologist. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,41.42,43 There are various methods and systems in place to obtain residents views. The formal QA system requires updating. There are appropriate arrangements in place to service and repair plant and equipment. The home has good Health and Safety arrangements. EVIDENCE: Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 22 Mr Rogers is continuing to work towards completing the manager’s award and is undertaking the assessor course. Regular staff meetings are arranged throughout the year. Regulation 26 visits are made monthly and reports submitted. A copy of the minutes for the residents meeting were seen, which, showed that residents are consulted about a range of in house matters. A key worker system is in place with regular team meetings and reviews. Regular social service reviews are completed for each resident. At present all the residents are have a reassessments of needs carried out. There are a set of house quality standards, which are reviewed monthly, it was agreed that these required revising and rewriting as the same standards had been in use for many years and some were out of date. A pictorial resident satisfaction survey has been carried out last year and the outcomes were positive as far as it went. The manager considers this document is of limited value with the current resident group and is looking to develop a new tool in due course. The need to update the QA assessment, resident survey and strategy for RN updating are to be addressed in the business plan, which is being written for the beginning of March. The Trust has Health & Safety policies and procedures and H&S audits are carried out regularly. A fire risk assessment under the work place regulations has been completed. A recent Fire officer visit has been carried out from which there are no requirements. The certificate for the fire alarm service could not be found. Proper service records were seen for the fire extinguishers, boilers, hoists and electrical installation. Hot water temperatures are monitored and logged. The home has a copy of the new infection control manual. There are proper arrangements to deal with clinical waste. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 23 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 3 2 3 3 X 4 3 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 3 26 X 27 3 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x X X 2 X 3 2 3 Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 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 YA42 YA30 Regulation 13.4 16.2 (j) Requirement Send a copy of the certificate for the inspection and service of the fire alarm system. Resolve washing machine drainage problem to prevent the spillage of dirty water. Timescale for action 10/03/06 10/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard 39 39 YA33 35 Good Practice Recommendations Revise and update the monthly qualitystandards and carry out audits. Devise a resident survey tool to have regard to quality of life and choice. Submit an application to vary staffing notice to amend night duty arrangements and shift times. write a stratergy for maintaining RN clinical updating in accord wit PREP requirements. Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Chasefield House DS0000020329.V274697.R01.S.doc Version 5.1 Page 26 - 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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