Inspection on 13/12/05 for Claremont Road Care Home

This inspection was carried out on 13th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Claremont Road Care Home 04/06/07

Claremont Road Care Home 14/06/06

Claremont Road Care Home 12/07/05

Claremont Road Care Home 03/02/05

Claremont Road Care Home 15/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Claremont Road Care Home 4 Claremont Road Sherwood Rise Nottingham NG5 1BH Lead Inspector Susan Lewis Unannounced Inspection 13th December 2005 10:00 Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 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 Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 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 and 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. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Claremont Road Care Home Address 4 Claremont Road Sherwood Rise Nottingham NG5 1BH 0115 841 3005 0115 9857579 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) Nottingham Community Housing Association Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: Claremont Road provides 12 places for adults with learning disabilities. It is a large detached property that is located close to the centre of Nottingham. The home is also conveniently situated for public transport, local shops and community facilities. The property is well maintained with a private rear garden. The home is accessible to people who are wheelchair users. There is a minibus provided for residents use. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the second in the inspection year 2005/06 and was carried out by 1 inspector. The manager was not in attendance as she had a commitment elsewhere. A number of residents were at various day activities but arrived back during the course of the day. Some residents, visitors and staff were spoken with during the course of the day. Staff files, which are held at the central office were requested, but due to shortage of staff these were not provided. What the service does well: 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. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 and 5 Prospective residents are able to visit the home prior to moving in and are given a written contract stating the terms and conditions of residency. EVIDENCE: The Nottingham Community Housing Association has a policy on planned admissions with residents being offered pre-admission visits including overnight stays. Each resident is offered a contract/statement of terms and conditions, which specifies their room to be occupied and what the residents can expect of the service and what responsibilities each party has. These are thorough and detailed documents and in some cases signed by the resident, however as these are legal documents they are complicated, and there appears to be no evidence that these contracts are written in a format Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 8 that the resident will understand. Nor are they supported by an advocate to enable them to understand what they are signing. Staff did report that where possible the contract is verbally explained to residents by staff. The Registered Person must ensure that every effort is made to enable prospective residents no exactly what they are signing and why. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 10 Individual plans address risks and residents can be confident that staff will handle any information in confidence. EVIDENCE: The support plans viewed during this inspection showed evidence of risk assessments taking place, enabling residents to take part in activities of their choice. The home has an unexplained absence policy and details how staff should respond to these absences. Support plans are completed on the electronic SuRe system which is updated regularly by the support workers. There is a confidentiality policy which staff adhere to and understand the importance of ensuring residents are able to share information in confidence. Staff spoken with also understood the importance of when to share information with the manager or others. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 A healthy diet is offered. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 11 EVIDENCE: Although a main meal was not observed on the day as the majority of residents were out at a variety of activities, there was clear evidence that residents are able to choose meals and are involved in their preparation. Menus are provided in pictorial form and are placed on the notice board in the kitchen. Residents who were at home on the day of the inspection were encouraged to choose their lunch and where possible be involved in its preparation. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 and 21 Residents health needs are met. EVIDENCE: Nottingham Community Housing Association has suitable policies and procedures for the safe handling of medication. Staff spoken with confirmed that they received training and support to ensure that medication was administered correctly. Medication was stored, handled, administered and disposed of appropriately. Records seen on the day of the inspection were signed correctly but the Registered Person must ensure that where medication has been hand written on the medication administration record sheet this should be signed and witnessed by staff to ensure it is correct. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 13 The Nottingham Community Housing Association has policies and procedures detailing how residents should be supported as and when their needs change and if they should deteriorate, this includes the possibility of supporting a resident’s move to another home if necessary. There are currently a number of residents whose needs are changing and staff are supporting those residents to the best of their ability. Evidence was seen that staff were seeking professional support elsewhere. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16, 18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 16, 18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were fully inspected at the last inspection on 12th July 2005. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The home currently meets the physical needs of the residents. EVIDENCE: Evidence was seen that where residents have physical needs they have a bedroom downstairs but as the home does not have a lift or stairs. Residents bedrooms have alarm systems and staff all carry pagers to alert them if someone needs them. There are currently no residents who use a hoist and intermediate care is not provided in this setting. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) 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 and 36 Staff are clear about their roles however they are being placed under strain due to the heavy reliance on bank staff. Recruitment practices are robust and provide protection to minimise potential abuse of residents. EVIDENCE: Evidence was seen on staff files that training is received and that all staff receive a standard induction prior to working at the project. Staff spoken with evidenced that they were accessible and comfortable with residents were good listeners and were committed to the home and the residents. Staff spoken with showed that they had a good understanding of the needs of the residents and the skills needed to support residents with challenging Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 17 behaviour. Staff confirmed that they were supported by management to access NVQ training. Due to the increased needs of two residents the staffing ratios have been increased and there is a heavier reliance on bank staff. Staff spoken with felt that although the bank staff used were regular and knew residents care needs it still placed staff under increased pressure and strain. In discussion with staff it was evident that there were a number of vacancies, but that these were due to be filled in the new year at the next round of Nottingham Community Housing Association recruitment. A variety of targets are used to encourage staff to minimise the amount of sick days lost but this did not stop staff leaving the project. Staff files were viewed during this inspection and were seen to contain two references and an up to date Criminal Records Bureau check. Staff have copies of their job description and statement of terms and conditions, copies of these are retained on file. Staff spoken with said that they have supervision but can be a bit ‘hit and miss’ and has recently got worse as one of the deputies has left. The registered person must ensure that all staff receive regular supervision. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 The overall management of the service safeguards the best interests of service users. Service users’ views and comments are valued and health and safety is promoted within the environment. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 19 EVIDENCE: The manager was not present during this inspection. However she has been a manager at this project for approximately three years and prior to that has been a registered at other Nottingham Community Housing Association projects. Staff spoken with said that the manager was supportive and approachable with an open management style. Relatives spoken with were also positive regarding the manager and her style. Nottingham Community Housing Association has an internal quality audit system whereby managers from other projects visit and ensure that Nottingham Community Housing Association’s policies and procedures are being adhered to. Nottingham Community Housing Association also use the Quality Tree system to work with residents to ensure that residents are receiving appropriate care and support. Evidence was seen of resident’s meetings as well as that policy and procedures were being reviewed. Maintenance records were looked at and all were up to date, however the PAT records could not be found, the registered person must ensure that all records are available for inspection. Water temperatures are checked regularly and evidence was seen for this. Fire drills and alarm tests are also carried out regularly. Accidents are recorded on The SuRe system and the manager prints them off regularly to audit them. Safe working practices are reviewed regularly, however it was commented on by staff that they were concerned about the practice of a resident who stands by the front door. If the door were not closed properly by someone entering or leaving the building the resident may leave the building unobserved. The registered person must ensure that this is risk assessed to ensure the security on the front door is appropriate to the needs of the residents. Only one requirement was set at the last inspection this was to keep walkways free from trip hazards and fire exits and hydrants must accessible. The area referred to is immediately outside the main office. There still appears to be the same material in this area as there was at the previous inspection. The registered person must risk assess this corridor and show that the material does not constitute a hazard. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 3 30 X STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 X 36 2 CONDUCT AND MANAGEMENT 37 3 38 3 39 3 40 X 41 X 42 2 43 X Standard No 6 7 8 9 10 LIFESTYLES 11 12 13 14 15 16 17 Score X X X 3 3 X X X X X X 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 3 Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 21 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 YA5 Regulation 5 Requirement The Registered Person must develop a standard form of contract for the provision of service and facilities by the registered provider to service users; that is more applicable to the needs of residents with a learning disability. The Registered Person shall having regard to the size of the home, the statement of purpose and the number and needs of the service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The Registered Person shall ensure that persons working at the care home are appropriately supervised. Timescale for action 01/04/06 2 YA33 18 01/02/06 3 YA36 12, 18 01/03/06 Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 22 4 YA42 13 5 YA42 Elec at work Regs The registered person shall 01/03/06 ensure that all parts of the home are so far as reasonably practicable free from hazards to their safety. Walkways must be kept free from trip hazards and fire exits and hydrants must accessible. A risk assessment must take place to show that this area is safe. (Outstanding requirement 22/07/05) The Registered Person must 01/03/06 ensure that information regarding electrical testing is available for inspection at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA42 Good Practice Recommendations Security of the premises and residents should be based on risk assessments. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. Claremont Road Care Home DS0000002248.V270120.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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