Inspection on 29/01/07 for Cherry Orchard

This inspection was carried out on 29th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cherry Orchard 18/12/07

Cherry Orchard 24/01/06

Cherry Orchard 29/07/05

Cherry Orchard 12/01/05

Cherry Orchard 02/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Cherry Orchard Cherry Avenue Clevedon North Somerset BS21 6HT Lead Inspector Justine Button Unannounced Inspection 29th January 2007 09:30 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 Cherry Orchard DS0000008139.V323257.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. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Orchard Address Cherry Avenue Clevedon North Somerset BS21 6HT 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) 01275 875418 01275 349173 cherryorchard@shaw.co.uk Shaw Healthcare (North Somerset) Ltd Ms Sara Jane House Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 36 persons aged 65 years and over requiring personal care only. Date of last inspection Brief Description of the Service: Cherry Orchard is a care home offering residential, respite and day care to older people in the Clevedon area. It is well sited in the community for local amenities and is also well known by local residents. The home offers single bedrooms over two floors. The upper floor is accessed via a passenger lift. There are a number of communal spaces including a large dining area and lounge with additional smaller lounges situated throughout the building. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of one day in January 2007. The inspector examined selected resident and staff files and looked at other documents relating to the running of the home including policies and procedures. The inspector spoke to the majority of residents, some staff and undertook a tour of the premises. The current fee levels are £353 to £412. Additional charges are made for hairdressing, chiropody, newspapers, toiletries and some social trips. Prior to the inspection information was sought from people living at the home, relatives and visiting professionals. This information was sought in the form of a questionnaire. In addition to this the management at the home completed a pre-inspection questionnaire. What the service does well: The home provides information to prospective residents and their relatives/representatives so that they can make an informed decision about moving into the home. All prospective residents and their families/representatives are given the opportunity to visit the home, spend time there and meet the staff and the manager before they moving. Admission procedures are thorough to ensure that prospective residents social, health and care needs can be met at the home. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity. Residents have right of access to healthcare and medical services. The care at the end stage of life are good. Residents are supported and encouraged to retain control of there own lives as much as possible. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 6 Residents to maintain contact with their family and friends and visitors are made welcome in the home. Residents were satisfied with the meals served in the home. Residents were confident that any complaints or concerns would be taken seriously. The policies and procedures regarding the protection of residents are clear and protect residents. Feedback from those living at the home and relatives was on the whole positive with the majority of people stating that their care needs were met. What has improved since the last inspection? What they could do better: The home does not employ a dedicated activites organiser. No activites were on offer on the day of the inspection. People living at the home stated that they would like to see an increased range of activites and social opportunities to be made available to them. The storage and administration of Medication was viewed during the inspection. The temperature of the fridge, used to store some medication, was not within expected safe limits. This may affect the properties of the medication stored within the fridge. The manager agreed to review this at the end of the inspection. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 7 A number of people living at the home had hand transcribed entries on the MAR (Medication Administration Record) These had not been completed in line with good practise guidelines. There is currently no quality assurance system in place within the home. The management should consider implementing such a system to ensure that they are offering a service in line with the needs of the people living at the home. The staff training matrix was viewed. This demonstrated that some staff require some mandatory training. 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. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 standard six is not applicable to this service. The quality outcome for this group is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home only take place if the service is confident that they are able to meet the assessed needs of the prospective resident. Each resident is provided with information about the home and a statement of terms and conditions before making a decision on residency. EVIDENCE: Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 10 The home produces a Statement of Purpose and a service users guide that gives information about the way the home is run to prospective residents and their family. The contract to occupy the care home accommodation is given to all prospective residents and their relatives/representatives. . The manager or a senior member of staff meets with prospective residents and their relatives/representatives and a pre admission assessment is undertaken to ensure that the home can meet their needs before they move into the home. The home also takes into account information provided by prospective residents GPs, district nurse and social services if funded via care management arrangements. Prospective residents are encouraged to visit the home and spend time there before making a decision on residency. There are extra charges for newspapers, hairdressing, chiropody, clothing and some trips and activities. These are charged at cost. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10. The quality of this group is poor. This judgement has been made using available evidence including a visit to this service. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity. Residents have right of access to healthcare and medical services. The care plans are in place and are reviewed regularly. Some improvements with regard to Medication procedures is required. EVIDENCE: Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 12 Five care and support plans were viewed during the inspection. Improvements have been made to the care planning process since the last inspection. The plans now contain all the necessary information. Staff need to ensure however that all assessments are reviewed and completed in full. For one person, for example, the Waterlow score (used to assess the risk of pressure sores) had not been completed fully. This gave an inaccurate final score and may have resulted in the staff not delivering the necessary care and support. Staff make daily statements with regard to the care and support that they have provided and the general state of health of the individuals living at the home. These statements are currently kept separate from the plans of care. The management should consider amalgamating these documents. People spoken to during the inspection had little or no knowledge of their plan of care. People living at the home and/or their representative should be involved in the care planning process to ensure that care and support is delivered in a way which the individual would like. The questionnaires sent to people living at the home and relatives by the CSCI asks “Do you receive the medical support you need ?” All people who responded to this question stated that they did. This was confirmed during the inspection with all people spoken to stating that they were registered with a GP. Care planning documentation confirmed that people living at the home had regular access to GP, dentist and opticians as and when required. Cherry Orchard does not provide nursing care. The home has good relationships with the community nursing team who visit the home to carry out any nursing care that is required. During the inspection the arrangements for medication were viewed. People living at the home are able to self medicate, if this is appropriate. Risk assessments are in place for these individuals. The risk assessments are reviewed regularly. Lockable storage is provided for all medication which is stored in individuals rooms. Medication administered by staff is stored securely in a dedicated room. During the inspection it was noted that the temperature of the drug fridge was not within safe limits being recorded at –3 to -7. This had been the case for a period of time and staff had not taken the appropriate action. Storing drugs at these temperatures may affect their properties and make them ineffectual. All the medication stored in this fridge should therefore not be used and destroyed. The management should ensure that staff are aware of the correct temperatures for drugs that require storage in a fridge. The Medication Administration Records (MAR) were viewed. At least eleven of these records had hand transcribed entries. When staff write a new prescription on the MAR the entry should be checked by a second person. This is done to reduce the risk of errors being made. This system was not in place for those entries seen on this inspection. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 13 Staff were observed administrating drugs in a safe manner on the day of the inspection. Staff were observed to treat residents with respect and the homes policies procedures and training make it clear that residents rights to privacy and dignity are paramount. People spoken to during the inspection stated that they were well supported. Comments included “I was very lucky to find such a lovely place” and “I hold the staff in the highest regard. They know if you are not feeling well and will do anything to help you.” Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15. The quality of this outcome group is poor. This judgement has been made using available evidence including a visit to this service. Residents are supported and encouraged to retain control of there own lives as much as possible. The opportunity for social and recreational activities is limited Residents to maintain contact with their family and friends and visitors are made welcome in the home. Residents were generally satisfied with the meals served in the home. EVIDENCE: The routines of the home are as flexible as possible to meet individual residents choices and preferences. Residents were able to choose to remain in their room or to meet with others in communal areas. The majority of residents’ files checked contained and activities plan with varying detail Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 15 The home does not employ a dedicated activites organiser. The notice board in the entrance hallway described the activites on offer as; Sunday- church service, Wednesday-hairdressing, Thursday- handicrafts, Saturday- bingo. In addition the management stated that trips to local places of interest occur particularly in the summer months. On the day of the inspection no activites were on offer. People living at the home both via the questionnaire and on the day of the inspection stated that they would like to see an increase in the social and recreational opportunities on offer. The homes statement of purpose states, “ a weekly varied programme of activites are planned and implemented” The evidence from the inspection does not support this statement. Consideration should be given to ascertaining the views of the people living at the home on what activites they would like to undertake and increasing the opportunities available. Residents spoken to confirmed that they were able to get up and go to bed at times of their own choosing. Residents are able to continue with their personal religious observance if they so wish and this was seen to have been noted on their individual file. The home actively encourages contact with residents’ family, friends and representatives and they are encouraged to take refreshments while visiting. Visiting can take place in communal areas or in residents’ private rooms. Lunch was viewed on the day of the inspection. The meal was well presented and was of an adequate standard. The meal on the day of the inspection included vegetable soup followed by cold meat, bacon or sausages served with sauté or bolied potatoes and baked beans. At least two people were seen to have a fried egg with their meal. Pears and custard was served as a pudding. Due to restrictions on dining space the main meal is served over two sittings. The kitchen was clean and tidy on the day of the inspection. The cook was present who was observed preparing the meal. All ingredients were fresh. Home made cakes were available and these were served with the evening meal. The menu stated that the evening meal was to be scrambled egg on toast or sandwiches. People spoken to during the inspection stated that the food was of a good standard. Comments included “food is excellent” A lighter cooked meal is available in the evening. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 16 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): 16,17,18 The quality of this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. Residents were confident that any complaints or concerns would be taken seriously. The policies and procedures regarding the protection of residents are clear and protect residents. Staff may not be aware of these procedures. EVIDENCE: The home had a complaints procedure on display in the entrance hall. All people\living at the home who were spoken to were clear about whom to talk to if they had a complaint or concern. two complaints have been received since the last inspection. These complaints have been investigated appropriately by the Company. The home had an appropriate adult protection policy and procedure that give clear guidelines to staff on how to recognise and report abuse of vulnerable Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 17 adults. According to the training matrix 12 care staff have not received training in this area. This is required. Staff files of those staff employed since the last inspection were viewed. Appropriate checks including Criminal Record Check and POVA had been completed. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 18 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): 19,20,21,22, 23,24,25,26 The quality of this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean tidy and well maintained. There are an adequate number of bathrooms that are accessible to all people living at the home. Bedrooms are well maintained. There are sufficient communal areas which are pleasant and well furnished. EVIDENCE: Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 19 Cherry Orchard was built and opened in the 1970’s. Due to this the design and layout of the home appears quite dated. All the bedrooms are relatively small but all are for single occupancy. None have en-suite facilities. There are however a number of bathrooms which are accessible and appropriate to meet the needs group of people living at the home. People moving into the home are able to bring in possessions to personalise their room. There is an ongoing programme of refurbishment and decoration. The home was clean and tidy on the day of the inspection. The homes maintenance records were viewed and these showed that the home is well maintained Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 20 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, 28,29,30 The outcome for this area is poor. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff on duty. Staff are trained, qualified and competent to fulfil their roles although some mandatory training is required. The homes recruitment policies do not safe guard the people living at the home. EVIDENCE: The duty rota’s provided with the information prior to the inspection were examined. These showed that there are adequate numbers of care staff on duty. In addition the home employs a range of ancillary staff. There were sufficient numbers of staff on duty on the day of the inspection. This included three care staff, One team leader, the manager, two domestic staff and one cook. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 21 There are currently 57 care staff hours vacant. One full time member of staff has recently been recruited to fill part of these hours. These hours are currently being covered by the existing staff. The impact on the people living at the home is therefore low. The inspector reviewed three staff files and was able to follow through the recruitment process operated by the organisation. Two of the staff files viewed did not contain two written references. Criminal Record Bureau checks had been obtained but these had not be returned prior to the individual commencing work with people living at the home. New staff employed complete a documented induction programme. This programme meets best practise guidelines. A number of staff have attended a recent fire drill, at least eight staff are now due this training. This may compromise the safety of people living at the home in an emergency situation. Only six of the care staff have received training in prevention and recognition of abuse. Five staff require updated training in moving and handling. It could not be confirmed if any staff had a current first aid certificate in such numbers that a first aider is on duty at all times. Three of the senior care staff have completed NVQ level 3 and an additional two staff are currently undertaking this training. Eleven of the eighteen care staff have an NVQ level 2. This is above the expected level of 50 . Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home benefits from a stable management team. Financial arrangements at the home are satisfactory. Staff receive regular supervision. Health and safety arrangements are on the whole satisfactory. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manger has been in post and registered by the CSCI for approximately 1995. People living at the home, staff and visitors stated that the manager was approachable and that they felt able to express any concerns they had to her. Representatives from the company visit the home regularly and audits are conducted. The system for safeguarding service users money was discussed with the staff and found to be appropriate; The discussion indicated that money is being signed for appropriately, and receipts attached to records. The home also provide secure facilities for residents, they have a lockable bedside cabinet. The inspector also noted that within care files there is a list of property bought in by residents on admission. Regular staff meetings are held. Although the minutes of these were not available. This gives staff the opportunity to express ideas and helps aid communication. Some staff have received supervision although this appeared to be spasmodic. All health & safety and maintenance checks were in place and up to date. Accidents are documented and these are audited regularly. This ensure that any remedial action required is taken. There are a range of risk assessments for the environment and building. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 24 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 25 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 OP30 Regulation 18(c) Requirement The registered manager must ensure that staff receives training appropriate to the residents’ needs. To include fire safety, moving and handling, prevention of abuse and first aid. Timescale for action 30/03/07 2 OP29 19 (1) (a) Schedule 2. 3 OP12 16 (2) (m) 4 OP9 13 (2) It is required that the manager 28/02/07 ensures that a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users is in place. This should include two written references and a Criminal Record Bureau check prior to the individual commencing work. The registered person shall 20/03/07 consult service users about their social interests and make arrangements to enable them to engage in local, social and community activites. The registered person shall make 01/03/07 arrangements for the recording, handling, safekeeping, safe administration of medicine at the home. Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 26 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 Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Cherry Orchard DS0000008139.V323257.R01.S.doc Version 5.2 Page 28 - 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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